Telemedicine among Adults Living in America during the COVID-19 Pandemic.

Background and Objectives Telemedicine can expand healthcare access to populations, but relying on technology risks a digital divide. Therefore, it is important to understand who utilizes telemedicine. This study explores telemedicine usage across socio-demographic groups in the United States during COVID-19. Methods Data came from the Household Pulse Survey (HPS) between 14 April 2021, to 11 April 2022. HPS is a rapid online response survey that assesses household experiences during COVID-19. We calculated descriptive statistics and used cross-correlation to test each pair of the time series curves. Results High school graduates used the least telemedicine (20.58%), while those with some college (23.29%) or college graduates (22.61%) had similar levels, and those with less than a high school education fluctuated over time. Black people had higher levels of use (26.31%) than Asians (22.01%). Individuals with disabilities (35.40%) used telemedicine more than individuals without disabilities (20.21%). Individuals 80 years or over (27.63%) used telemedicine more than individuals 18 to 29 years old (18.44%). Cross-correlations for the time series pairs across demographics revealed significant differences in telemedicine use for all demographic groups over time. Conclusions Overall, elderly, Black people, individuals with some college, and persons with disabilities report higher levels of telemedicine use. Telemedicine may improve healthcare access post-pandemic, but more research is needed to understand factors that drive differences among groups.

Impact of Social Isolation and Digital Divide on Mental Health and Wellbeing in Patients with Mental Health Disorders during COVID-19: A Multiple Case Study.

The positive relationship between social connections and mental health and wellbeing has been widely documented. During the initial stage of the pandemic, COVID-19 associated restrictions had given rise to social isolation that had a negative effect on individuals' mental health and wellbeing, particularly among patients with preexisting mental health disorders. To abridge physical distance, digital technology had become a primary method of communication and social engagement. However, not everyone had access to internet and devices required to connect online due to the digital divide, especially among marginalized populations. The purpose of this multiple case study was to explore experiences of social isolation and the digital divide among patients with mental health disorders, and its impact on their mental health and wellbeing. Our findings revealed that social isolation was the major contributing factor to the intensification of mental health symptoms, while the digital divide (e.g., financial constraints and low proficiency in digital technology) was recognized as a barrier to making social connections via digital technologies. Nurses should engage with communities and policymakers in developing strategies to address the social determinants of health disparities during the current pandemic, other disruptive pandemics and beyond.

Trajectory tracking of changes digital divide prediction factors in the elderly through machine learning.

RESEARCH MOTIVATION: Recently, the digital divide problem among elderly individuals has been intensifying. A larger problem is that the level of use of digital technology varies from person to person. Therefore, a digital divide may even exist among elderly individuals. Considering the recent accelerating digital transformation in our society, it is highly likely that elderly individuals are experiencing many difficulties in their daily life. Therefore, it is necessary to quickly address and manage these difficulties. RESEARCH OBJECTIVE: This study aims to predict the digital divide in the elderly population and provide essential insights into managing it. To this end, predictive analysis is performed using public data and machine learning techniques. METHODS AND MATERIALS: This study used data from the '2020 Report on Digital Information Divide Survey' published by the Korea National Information Society Agency. In establishing the prediction model, various independent variables were used. Ten variables with high importance for predicting the digital divide were identified and used as critical, independent variables to increase the convenience of analyzing the model. The data were divided into 70% for training and 30% for testing. The model was trained on the training set, and the model's predictive accuracy was analyzed on the test set. The prediction accuracy was analyzed using logistic regression (LR), support vector machine (SVM), K-nearest neighbor (KNN), decision tree (DT), and eXtreme gradient boosting (XGBoost). A convolutional neural network (CNN) was used to further improve the accuracy. In addition, the importance of variables was analyzed using data from 2019 before the COVID-19 outbreak, and the results were compared with the results from 2020. RESULTS: The study results showed that the variables with high importance in the 2020 data predicting the digital divide of elderly individuals were the demographic perspective, internet usage perspective, self-efficacy perspective, and social connectedness perspective. These variables, as well as the social support perspective, were highly important in 2019. The highest prediction accuracy was achieved using the CNN-based model (accuracy: 80.4%), followed by the XGBoost model (accuracy: 79%) and LR model (accuracy: 78.3%). The lowest accuracy (accuracy: 72.6%) was obtained using the DT model. DISCUSSION: The results of this analysis suggest that support that can strengthen the practical connection of elderly individuals through digital devices is becoming more critical than ever in a situation where digital transformation is accelerating in various fields. In addition, it is necessary to comprehensively use classification algorithms from various academic fields when constructing a classification model to obtain higher prediction accuracy. CONCLUSION: The academic significance of this study is that the CNN, which is often employed in image and video processing, was extended and applied to a social science field using structured data to improve the accuracy of the prediction model. The practical significance of this study is that the prediction models and the analytical methodologies proposed in this article can be applied to classify elderly people affected by the digital divide, and the trained models can be used to predict the people of younger generations who may be affected by the digital divide. Another practical significance of this study is that, as a method for managing individuals who are affected by a digital divide, the self-efficacy perspective about acquiring and using ICTs and the socially connected perspective are suggested in addition to the demographic perspective and the internet usage perspective.

A digital divide in the COVID-19 pandemic: information exchange among older Medicare beneficiaries and stakeholders during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic resulted in unprecedented challenges for older adults. Medicare enrollment was already an overwhelming process for a high fraction of older adults pre-pandemic. Therefore, the purpose of this qualitative study was to gain understanding from community organizations and stakeholders about their pre-pandemic and during-pandemic experiences while adapting to continue offering insurance advice to seniors, what resources are available to seniors, and what needs to be done to help seniors make higher quality insurance choices in the Medicare program. In addition, we wanted to explore how the COVID-19 pandemic may have changed the ways that these stakeholders interacted with Medicare beneficiaries. METHODS: We employed a qualitative strategy to gain a deep understanding of the challenges that these organizations may have faced while offering advice/counseling to older adults. We accomplished this by interviewing a group of 30 stakeholders from different states. RESULTS: Every stakeholder mentioned that some older adults have difficulty making Medicare decisions, and 16 stakeholders mentioned that their system is complex and/or overwhelming for older adults. Twenty-three stakeholders mentioned that Medicare beneficiaries are often confused about Medicare, and this is more noticeable among new enrollees. With the onset of the pandemic, 22 of these organizations mentioned that they had to move to a virtual model in order to assist beneficiaries, especially at the beginning of the pandemic. However, older adults seeking advice/meetings have a strong preference for in-person meetings even during the pandemic. Given that the majority of the beneficiaries that these stakeholders serve may not have access to technology, it was difficult for some of them to smoothly transition to a virtual environment. With Medicare counseling moving to virtual or telephone methods, stakeholders discussed that many beneficiaries had difficulty utilizing these options in a variety of ways. CONCLUSIONS: Findings from our interviews with stakeholders provided information regarding experiences providing Medicare counseling pre- and during-COVID-19 pandemic. Some of the barriers faced by older adults included a complex and overwhelming system, a strong preference for in-person meetings among beneficiaries, challenges with technology, and an increased risk of information overload and misinformation. While bias may exist within the study and sample, given that technology-savvy beneficiaries may not seek help from organizations our study participants work in, they show how the current Medicare system may impact vulnerable older adults who may need support with access to high-speed internet and digital literacy.

A systematic review of videoconferencing in health professions education: the digital divide revisited in the COVID-19 era.

OBJECTIVES: During the COVID-19 pandemic, educators shifted from traditional lectures to videoconferencing. This systematic review explored the use of videoconferencing as a teaching tool in response to the pandemic as well as issues related to digital equity and inclusion. CONTENT: The review was conducted using the Joanna Briggs Institute for Systematic Reviews methodology and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. SUMMARY: A total of nine studies met eligibility criteria. The participants in the included studies were medical students from various parts of the world. Technical difficulties and lack of human interactions were identified as barriers to learning through videoconferencing. OUTLOOK: To achieve full success, pedagogical videoconferencing must prioritize digital equity and a universal design for learning. Although useful for maintaining education during the pandemic, in the future, videoconferencing will present challenges related to the digital divide as well as opportunities as a teaching tool for nurse educators globally.

Exploring the Digital Divide among the Bhutanese Refugee Community during COVID-19: Engaged Research in Action.

The digital divide proved a critical barrier to accessing information and healthcare during the COVID-19 pandemic and negatively impacted the Bhutanese refugee community. Moving beyond a technological model of the digital divide that highlights a lack of access to computers and the internet, we engaged the community to co-produce a dynamic approach that identifies the impact of socio-cultural and socio-environmental factors as well. Our paper reports on our community-academic research partnership and explores how the digital divide exacerbates health disparities in a midwestern Bhutanese refugee community. Combining the efforts of the community, anthropologists and social workers, this paper reports on the health disparities that confront the community as well as interventions designed to mitigate social inequities.

Age, race, insurance type, and digital divide index are associated with video visit completion for patients seen for oncologic care in a large hospital system during the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic drove rapid adoption of telehealth across oncologic specialties. This revealed barriers to telehealth access and telehealth-related disparities. We explored disparities in telehealth access in patients with cancer accessing oncologic care. MATERIALS/METHODS: Data for all unique patient visits at a large academic medical center were acquired pre- and intra-pandemic (7/1/2019-12/31/2020), including visit type (in-person, video, audio only), age, race, ethnicity, rural/urban (per zip code by Federal Office of Rural Health Policy), distance from medical facility, insurance, and Digital Divide Index (DDI; incorporates technology/internet access, age, disability, and educational attainment metrics by geographic area). Pandemic phases were identified based on visit dynamics. Multivariable logistic regression models were used to examine associations of these variables with successful video visit completion. RESULTS: Data were available for 2,398,633 visits for 516,428 patients across all specialties. Among these, there were 253,880 visits from 62,172 patients seen in any oncology clinic. Dramatic increases in telehealth usage were seen during the pandemic (after 3/16/2020). In multivariable analyses, patient age [OR: 0.964, (95% CI 0.961, 0.966) P<0.0001], rural zip code [OR: 0.814 (95% CI 0.733, 0.904) P = 0.0001], Medicaid enrollment [OR: 0.464 (95% CI 0.410, 0.525) P<0.0001], Medicare enrollment [OR: 0.822 (95% CI 0.761, 0.888) P = 0.0053], higher DDI [OR: 0.903 (95% CI 0.877, 0.930) P<0.0001], distance from the facility [OR: 1.028 (95% CI 1.021, 1.035) P<0.0001], black race [OR: 0.663 (95% CI 0.584, 0.753) P<0.0001], and Asian race [OR: 1.229 (95% CI 1.022, 1.479) P<0.0001] were associated with video visit completion early in the pandemic. Factors related to video visit completion later in the pandemic and within sub-specialties of oncology were also explored. CONCLUSIONS: Patients from older age groups, those with minority backgrounds, and individuals from areas with less access to technology (high DDI) as well as those with Medicare or Medicaid insurance were less likely to use video visits. With greater experience through the pandemic, disparities were not mitigated. Further efforts are required to optimize telehealth to benefit all patients and avoid increasing disparities in care delivery.

Telehealth and the Digital Divide: Identifying Potential Care Gaps in Video Visit Use.

In recent years, telehealth visits have surged in response to the COVID-19 pandemic. However, existing structural inequities impact the access and use of information technology based on social and geographical characteristics, which is referred to as the digital divide. This has created disparities between patients with access to video visits vs. telephone visits. Previous telehealth research has focused on the completion of video visits. However, further research is needed to understand patients who decline video visits and rely on phone visits. We conducted semi-structured interviews (n = 13) of older patients (n = 9) and clinical support staff (n = 4) to understand the barriers in accessing virtual care. Most patients reported feeling left behind with telehealth, despite having access to a computer or smartphone. Clinical staff identified access to reliable technology and the ability for patients to navigate the technology as primary barriers to accessing virtual care. Many patients indicated an interest in video visits, but wanted low tech solutions and at-the-elbow support to build confidence with the technology.

Disconnected in a pandemic: COVID-19 outcomes and the digital divide in the United States.

The COVID-19 pandemic has exacerbated inequalities related to the digital divide. With wide adoption of remote working and learning, telehealth, and virtual events and social activities, the technology have-nots and know-nots experienced substantial marginalization and elevated risks of COVID-19 exposure in daily lives. This study discusses the pathways through which digital exclusion could aggravate the impacts of the pandemic and explored the linkage between digital access and COVID-19 outcomes in U.S. counties. It finds that counties with higher percentages of digitally excluded populations have seen higher COVID-19 case and death rates throughout the pandemic and lower vaccination rates by January 2022.

Progress towards enhanced access and use of technology during the COVID-19 pandemic: A need to be mindful of the continued digital divide for many rural and northern communities.

The COVID-19 pandemic produced unprecedented adoption and deployment of technology in rural and northern areas; however, this expansion widened the digital divide for many. Evidence shows that older adults' use of technology has increased. Coupled with an increasing number of available technologies to enhance healthcare delivery, social engagement, meaningful activities, and support to carers, we are at a crossroads for change. Emerging strategies used by organizations to promote technology and support efforts to bridge and close the digital divide are discussed. In a post-pandemic society, policy-makers can play a critical role to ensure that improvements, efficiency gains, and lessons learned are fully leveraged to reap the benefits of technology use by older adults, care partners, and the healthcare system. Recommendations are given for policy-makers to capitalize on this opportunity to narrow the digital divide for those in rural and northern communities.

Diverse Recruitment Strategies Are Needed to Reduce Digital Divide: Results from a Workshop Addressing Digital Divide and Effects of Pandemic Restrictions.

Recruitment is a bottleneck for research - especially digital health studies. Studies often focus on those who are easy to reach or already engaged in their health, leaving those who are uninterested or un-engaged, as "un-reached". This contributes to the "digital divide". COVID-19 restrictions made recruitment more difficult. During a virtual workshop of our peers, we discussed recruitment of un-reached groups for digital health studies, especially during COVID-times. All agreed; we need to go where the un-reached are by collaborating with community-based services and organizations.

Exploring the Digital Divide as a Barrier to Use of a Personal Health Record in the Elderly.

The digital divide can hinder the ability of elderly patients to fully benefit from PHRs. They are "digital immigrants", not having the life-long exposure to technology as younger generations, as well as physical and cognitive disabilities. The aim of this study was to explore the digital divide as a barrier for the use of a PHR in older adults (> 69 years of age) and describe the use of a PHR in an elderly population in Argentina. We conducted a cross sectional study which included older adults who attended the Coronavirus vaccination campaign in 2021. Data were collected through a survey encompassing digital divide factors and use of the PHR. A total of 128 participants agreed to complete the survey, 60.15% reported using the PHR. We found a statistically significant correlation of education level, having a personal computer and internet access with PHR use. Concerning PHR users, 45.45% reported needing assistance to use it. Although the elderly population represents a large portion of patients, there is not enough research done on their use experience using eHealth solutions. There is pending work in the eHealth field to integrate these elders into current PHRs and help them enjoy their benefits.

Rethinking the Digital Divide: Using an Internet Survey in a Flint Water Crisis Medicaid Population.

This project examined the preferred mode of response (internet, phone, mail) to a health services survey. Data were collected via survey responses from a subsample of Flint Water Crisis Medicaid Expansion Waiver enrollees (N=2,584). Analyses were stratified by age, residency, race, and income. Chi-square tests were used to detect categorical differences. The majority of participants responded by internet (55.5%), followed by mail (39.4%), and phone (5.2%). Of those responding by internet, 75% used smartphones for connectivity. Black and White respondents used the internet at a greater rate than Hispanic respondents (p<.01). Respondents at 200% federal poverty level (FPL) or higher used the internet mode at greater rates than those below 200% FPL (p<.01). Our findings suggest greater internet use in a vulnerable population than expected, but the digital divide persists. In the advent of COVID-19, this finding can inform future health programming using digital communication and telehealth.

The Digital Divide of Know-How and Use of Digital Technologies in Higher Education: The Case of a College in Latin America in the COVID-19 Era.

To determine whether or not digital inequalities exist, the frequency, duration, satisfaction, importance, and perceived competence of eighteen groups of digital tools during the COVID-19 pandemic confinement were examined. An online survey was administered to 2882 Latin American university students (49% female; M = 21.3 years). The following items are checked: (1) increased digital inequalities during the pandemic; (2) adequate reliability and validity of the Digital Technology Survey (DTS) instrument; (3) patterns of digital inequalities to the detriment of men, lower strata and unemployed people; and (4) evidence that the importance of digital activities as a causal factor on satisfaction with such digital activities as an outcome is mediated by the purpose of use and communication recipients, but not by strata or employment status, nor moderated by gender. The results are discussed in the light of previous studies, the limitations of the study and future perspectives.

Digital Divide in Online Education During the COVID-19 Pandemic: A Cosmetic Course From the View of the Regional Socioeconomic Distribution.

Objectives: During the pandemic, quarantine has led to the lockdown of many physical educational institutions. Thus, massive open online courses (MOOCs) have become a more common choice for participants. MOOCs are often flagged as supplemental methods to educational disparities caused by regional socioeconomic distribution. However, dissenters argue that MOOCs can exacerbate the digital divide. This study aimed to compare the participants' performance before and after the outbreak of COVID-19, analyze the impact of the epidemic on online education of cosmetic dermatology from the view of the regional socioeconomic distribution, and investigate whether MOOCs exacerbate the digital divide in the COVID-19 epidemic. Methods: The study was conducted in participants of the MOOC course Appreciation and Analysis of Cosmetics from January 2018 to December 2020. Based on the platform data and official socioeconomic statistics, correlation of multivariate analysis was used to determine the factors related to the number of total participants. A panel regression model and stepwise least squares regression analysis (STEPLS) were employed to further analyze the relationship between GDP, population, number of college students and number of total participants in different years in the eastern, central and western regions of China. Results: The number of total participants in 2020 surged 82.02% compared with that in 2019. Completion rates were generally stable in 2018 and 2019 before the COVID-19 pandemic and significantly decreased in 2020 after the outbreak of the pandemic. GDP was the most important socioeconomic factor that determined the total number of participants and it was positively related to the total number of participants before and after the outbreak of the pandemic. The number of college students was unrelated to the total number of participants before the epidemic, and after the outbreak of COVID-19 in 2020, the number became positively related in all regions of China. Conclusions: This study shows that the epidemic pushes more people to choose MOOCs to study cosmetic dermatology, and online education could exacerbate rather than reduce disparities that are related to regional and socioeconomic status in the cosmetic field in the COVID-19 pandemic.

The digital divide impacts on mental health during the COVID-19 pandemic.

One of the most daunting unintended consequences of the digital revolution is the digital divide (DD), a pervasive social and information inequality. It negatively affects all sectors of society, and exerts compounding influences on other social inequities. To further complicate the situation, the COVID-19 pandemic has been intensifying the scale of DD and deepening the scope of DD barriers with the increasing but imbalanced applications of digital technologies. For instance, while digital technologies can provide support to fulfill people's mental health needs, recurring evidence shows that DD-prone people are more likely to be excluded from critical services, activities, and resources to support their health concerns and challenges. So far, studies about the mental health consequences of DD amid COVID-19 are limited. Available evidence suggests that the general mental health impacts of COVID-19 include anxiety, depression, and suicidal behaviors, while the mental health consequences of DD due to COVID-19 are mainly stress, distress, and anxiety. To shed light on the research gap, based on the social inequality roots of DD and the nexus between DD barriers and factors of social inequalities, this study highlights the alarming overlap between DD-prone communities and vulnerable populations. Furthermore, we underscore the future research directions that could help society better serve both underserved communities.