Impacts of the Internet on Health Inequality and Healthcare Access: A Cross-Country Study

Internet use for health information, health service utilization, and quality of care in the U.S

BACKGROUND

Increased internet use for health information in the United States enhances interactions with healthcare professionals, but its effects on healthcare utilization and care quality are still being investigated. We explored the association between internet use for health information, patient-centered communication (PCC), and sociodemographic factors on the likelihood of visiting a health care provider and quality of care. We also examined if PCC mediates this association.

METHODS

We conducted a secondary data analysis using the National Cancer Center Institutes (NCI) Health Information National Trends Survey (HINTS) 2018-2020. Multinomial logistic regression and path analyses assessed variable interrelationships and mediating effects.

RESULTS

Individuals using the internet for health information for themselves were 2.40 times more likely (P <.001) to have frequent provider visits and 1.18 times more likely (P <.022) to rate their care as very good/good compared to excellent, compared to those who did not use the internet for health information for themselves. In contrast, individuals using the internet for discussion with their providers were 2.05 times more likely (P <.001) to have increased visits, and they were 40% less likely (P <.001) to rate their care as fair/poor compared to excellent, relative to those who did not use the internet for discussions. Path analysis indicated that individuals using the internet for health information for themselves may negatively impact PCC, resulting in lower quality ratings, while those who use the internet for discussions with healthcare providers had a positive effect on PCC, leading to higher care ratings.

CONCLUSION

This study enhances our understanding of how PCC and internet use for health information impact US healthcare. Using the internet for provider discussions positively impacts perceived care quality, highlighting PCC's vital role.

A Review and Promise of Digital Health Technologies to Promote Global Cardiovascular Health: A Call to Action for Nursing

BACKGROUND

Digital health technologies include an array of mobile or digital devices and apps that may be used by patients to support lifestyle modification or medical apps that monitor vital parameters and provide data that may influence treatment decisions. The use of digital health technologies is a growing opportunity for disease prevention and management of cardiovascular disease (CVD) for both patients to engage in self-management as well as nurses to monitor patients remotely and facilitate clinical decision support.

OBJECTIVES

The aims of this review article are to provide an overview of pertinent digital health technologies in CVD care, address social determinants of health and other enablers/barriers to digital health implementation, and provide perspectives on novel models of care incorporating digital technologies.

METHODS

Based on the latest evidence, recommendations for special considerations and implementation of digital health technologies in low- and middle- versus high-income countries are presented. In addition, tables reviewing functionality of the digital tools and global examples of their use are provided. Extensive empirical evidence from diverse populations suggests adoption of these innovative tools has been low in clinical settings. We provide a table summarizing these barriers and include the facilitators that can improve the adoption of digital health tools to improve behavioral lifestyle modification.

CONCLUSIONS

For learning purposes, implementation of an innovative model of care is illustrated graphically and in text. We include a call to action to achieve the maximum impact of digital technology to support nurses who work in almost all settings improving CVD prevention and management globally. The multiple roles of nurses using digital health for global CVD prevention and management are discussed in the settings of clinical practice, research, education, public health, health policy/leadership, and informatics.

The Impact of the Digital Economy on Health Inequality: Micro Evidence From China

BACKGROUND

In the context of China's goal of pursuing health equity and the economic context of the booming digital economy, it is important to analyse whether the digital economy has mitigated income-related health inequality and how it works.

METHODS

By matching urban macro-data with individual micro-data, the study obtains mixed panel data at the individual level for five periods from 2012 to 2020. The entropy method is used to comprehensively measure both the level of urban digital economy development and residents' health. The concentration index method was used to measure the extent of health inequality between residents at different income levels. Furthermore, the study uses the recentered influence function (RIF_CI_OLS) regression model to empirically test the impact of the digital economy on health inequality and its underlying mechanisms.

RESULTS

We found that, first, the digital economy significantly alleviates health inequality among groups with different income characteristics, by providing year-by-year insights into the contribution of the digital economy to health inequality, we find that the digital economy plays a significant and positive long-term role in promoting health equity. Second, a mediated effects model is used to test the mechanisms by which the digital economy mitigates health inequality. The results show that the digital economy reduces health inequality between groups with different income characteristics by increasing the accessibility of healthcare services to the population. Third, there is obvious regional and individual heterogeneity in the impact of the digital economy on health inequality. The digital economy has a greater mitigating effect on health inequality among residents of urban, eastern, and central regions. The impact of the digital economy on health inequality does not show significant heterogeneity in terms of gender, but there is a significant differential effect in terms of age, with the digital economy significantly alleviating health inequality in the 45-60 years old group, and the effect on the other age groups is statistically significant. Overall, the digital economy plays a significant positive role in narrowing health inequality among different income groups. Although its facilitating effect is relatively weak in regions with underdeveloped digital economies, in the long term, as digital technology improves, the inclusive effect of the digital economy will gradually emerge, promoting the equitable sharing of health benefits among various groups and thereby further promoting health equity.

CONCLUSIONS

Strengthening digital infrastructure, promoting the development of the digital health industry, and improving the digital literacy of the population-especially by increasing digital support for less-developed regions such as the west and rural areas, as well as for disadvantaged groups such as those with low incomes and low education, and the elderly-will ensure that the health dividends brought about by the digital economy benefit the entire population.

A study on the impact of digital infrastructure development on the health of low-income rural residents: based on panel data from 2010 to 2022

The health status of low-income rural residents is intricately linked to social equity and justice and the realization of the goal of common prosperity. Based on the CFPS data from 2010 to 2020 and the list of "Broadband China" demonstration cities, this paper employs a multi-period Difference-in-Differences (DID) approach to empirically analyze the impact of digital infrastructure construction on the health of low-income rural residents and its mechanism. The results indicate that: (1) Digital infrastructure construction had a significant positive impact on the health of rural low-income residents. After adjusting the sample period, changing the policy implementation time point, excluding other policy interference, and Propensity Score Matching-Difference-in-Differences (PSM-DID), the model was still robust. (2) The mechanism test found that digital infrastructure would improves the health of rural low-income residents through three mechanisms: the adoption of new agricultural technology, land transfer, and leisure time. (3) In terms of heterogeneity analysis, based on region type, education level, marital status and public supporting system, digital infrastructure construction can enhance the health status of low-income rural residents in the western region, those with low education level, married people and those with more public supporting system. This study suggests the continued promotion of the construction of digital infrastructure, with a focus on the construction level of the western and western regions, narrow the "digital divide" between different groups, and improve public supporting facilities in backward rural areas, so as to further enhance the health status of low-income groups.

OVision A raspberry Pi powered portable low cost medical device framework for cancer diagnosis

Cancer remains a major global health challenge, with significant disparities in access to advanced diagnostic and prognostic technologies, especially in resource-constrained settings. Existing medical treatments and devices for cancer diagnosis are often prohibitively expensive, limiting their reach and impact. Pathologists' scarcity exacerbates cancer diagnosis accuracy, elevating mortality risks. To address these critical issues, this study presents OVision - a low cost, deep learning-powered framework developed to assist in histopathological diagnosis. The key objective is to leverage the portable, low-power computing Raspberry Pi. By designing standalone devices that eliminate the need for internet connectivity and high-end infrastructure, we can dramatically reduce costs while maintaining accuracy. As a proof of concept, the study demonstrated the viability of this framework through a compact, self-contained device capable of accurately detecting ovarian cancer subtypes with 95% accuracy, on par with traditional methods, while costing a small fraction of the price. This portable, off-grid solution has immense potential to improve access to precision cancer diagnostics, especially in underserved regions of the world that lack the resources to deploy expensive, infrastructure-heavy medical technologies. In addition, by classifying each tile, the tool can provide percentages of each histologic subtype detected within the slide. This capability enhances the diagnostic precision, offering a detailed overview of the heterogeneity within each tissue sample, helps in understanding the complexity of histologic subtypes and tailoring personalized treatment plans. In conclusion, this work proposes a transformative model for developing affordable, accessible medical devices that can bring advanced healthcare benefits to all, laying the foundation for a more equitable, inclusive future of precision medicine.

Generational differences in healthcare: the role of technology in the path forward

Healthcare systems worldwide are under increasing pressure due to aging populations, rising prevalence of chronic diseases, and heightened patient expectations. Generational differences significantly impact perceptions of health, healthcare decision-making, use of digital technologies, and attitudes toward preventative health. This perspective article explores these differences through the lens of Generational Cohort Theory, focusing on six generations: the Silent Generation, Baby Boomers, Generation X, Millennials, Generation Z, and Generation Alpha. We highlight how each cohort's unique experiences shape their healthcare values, preferences, and engagement with digital health technologies. Younger, tech-savvy generations demand personalized, data-driven healthcare solutions, while older generations often face barriers to adopting digital tools due to limited digital literacy. The article emphasizes the importance of tailoring healthcare delivery, including hybrid care models, to accommodate diverse generational preferences. It further addresses the role of artificial intelligence, wearable technologies, and mobile health apps in preventative care and the need for targeted education to bridge the digital divide and combat misinformation. We propose strategies to integrate digital health solutions and generationally sensitive communication approaches, ensuring equitable access to healthcare services and fostering patient empowerment. Ultimately, this work underscores the need for a multi-faceted, inclusive approach to healthcare delivery to meet the demands of an evolving patient demographic and drive progress in public health systems.

Determinants of poor access to health care among women of reproductive age in Sierra Leone: a cross-sectional study

BACKGROUND

Sierra Leone, like many developing countries, faces challenges in ensuring equitable access to healthcare, particularly for women of reproductive age. This women has specific healthcare needs related to sexual and reproductive health, maternal health, and family planning. Despite improvements in national healthcare coverage, disparities persist, with women of reproductive age, especially those in rural areas and lower socio-economic brackets, experiencing significant barriers to accessing essential services. The study examined the factors associated with poor access to healthcare among women in Sierra Leone.

METHODS

The study utilised the cross-sectional 2019 Sierra Leone Demographic Health Survey. The study included 15,574 women of reproductive age (15-49 years) in Sierra Leone. A mixed-effect multilevel binary logistic regression analysis was conducted, determining the factors associated with poor access to healthcare using a four-modeled approach. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI).

RESULTS

From our study the proportion of poor access to healthcare was 71.9% [69.7,74.0] in Sierra Leone. Previously married women(divorced, separated, or widowed) [aOR = 1.74; 95% CI: 1.30, 2.34] had higher odds of poor access to healthcare than those never in a union. Women living in rural areas [aOR = 1.88; 95% CI: 1.30, 2.71] had higher odds of poor access to healthcare than those living in urban areas. Women with secondary [aOR = 0.74; 95% CI: 0.62, 0.89] and higher education [aOR = 0.48; 95% CI: 0.34, 0.68] had lower odds of poor healthcare access than those without education. Women who watch television [aOR = 0.70; 95% CI: 0.56, 0.86] had lower odds of poor access to healthcare than those who did not. Richer [aOR = 0.57; 95% CI: 0.42, 0.79] and Richest quintile women [aOR = 0.45; 95% CI: 0.32, 0.65] have lower odds of poor access to healthcare than women in the poorest quintile. Women living in the Western region [aOR = 0.38; 95% CI: 0.22, 0.65] have lower odds of poor access to healthcare than those living in the Eastern region.

CONCLUSION

Our study revealed that poor access to healthcare is a significant issue in Sierra Leone. Women who were previously married (divorced, separated, or widowed), lived in rural areas, or had lower education levels faced higher odds of poor healthcare access. Conversely, women with higher education, greater wealth, watch television, and those residing in the Western region had significantly lower odds of poor healthcare access. These findings underscore the need for targeted interventions addressing socioeconomic, educational, and provincial disparities to improve healthcare access for women in Sierra Leone.

The impact of digital literacy in enhancing individuals' health in China

BACKGROUND

Health is the cornerstone of individual well-being and a vital factor in socioeconomic development. In an increasingly digitalized world, digital literacy has emerged as one of the indispensable abilities, which not only pertains to an individual's capacity to acquire, analyze, evaluate, and utilize information but also profoundly influences their health behaviours, health decisions, and overall well-being. This paper uses the 2020 China Family Panel Studies (CFPS) data to explore digital literacy's impact on individuals' health.

METHODS

By using the Entropy-TOPSIS method, this paper calculates digital literacy as a three-dimensional construct and adopts Ordered Probit and OLS models to analyze the impact of digital literacy on physical and mental health. Additionally, this paper employs the Two-Stage Least Squares (2SLS) to address endogeneity issues. The indirect effects of income, employment quality, and informal social support on individual's digital literacy and health nexus are also examined by the mediation effect model.

RESULTS

The results indicate that digital literacy positively impacts individuals' physical and mental health, which was confirmed by several robustness tests. The heterogeneity analysis shows that digital literacy is more effective in enhancing the health of middle-aged and older groups as well as rural individuals in China. According to mechanism analysis, digital literacy can enhance individuals' health by boosting income, improving employment quality, and expanding informal social support; however, the effects vary on physical and mental health.

CONCLUSION

Several policy suggestions emanate from the findings. To enhance the positive impact of digital literacy on individuals' health, the policy makers should emphasize on enhancing digital literacy particularly in rural areas and older age groups, bridging the digital divide, refining employment services and embracing a healthy concept of online social networking.

Exploring health outcome disparities in African regional economics communities: a multilevel linear mixed-effect analysis

BACKGROUND

In African Regional Economic Communities (RECs), notable and enduring disparities exist in health outcomes. This study investigates the impact of macro-level characteristics of countries on health outcomes disparities within the African Regional Economic groupings. The study used panel data from the World Bank Development Indicators (WDI) and the Worldwide Governance Indicators (WGI), spanning 37 African countries, grouped into eight RECs between 2000 and 2019. We employed infant and under-five mortality rates and life expectancy at birth as indicators of health outcomes.

METHOD

The study used a multilevel linear (ML) mixed-effect approach to examine the influence of country-level factors on health outcome disparities within the eight African RECs recognized by the African Union.

RESULTS

The findings show that higher unemployment rates and HIV incidence exacerbate these disparities, while a growing elderly population and improved access to basic drinking water can mitigate them. Increased internet usage correlates with higher within-regional inequalities in child mortality rates but reduces disparities in life expectant at birth. Urbanization trends contribute to lower-intra-regional inequality in infant mortality rates and life expectancy at birth. Higher domestic government health expenditure as a share of general government spending is linked to reduced disparities in under-five and infant mortality rates. Still, it increases inequalities in life expectancy at birth within the regional groupings. Moreover, a higher proportion of the population below 15 years old and trade gains positively influence regional disparities in life expectancy. Conversely, DTP immunization coverage among children aged 12-23 months is associated with higher within-regional inequality in infant mortality rates.

CONCLUSIONS

Polices aimed at reducing unemployment rates and HIV incidence should be prioritized. In addition, governments should invest in elderly care programs and infrastructure development for water supply. Efforts to promote internet access should be complemented by interventions to enhance child health and healthcare accessibility. Encouraging urban planning policies that prioritize developing healthcare infrastructure and facilitating healthcare access in urban areas is crucial. Furthermore, Governments should increase their health expenditure allocation in general government spending. Promoting strategies to enhance healthcare access and quality for specific demographics, alongside leveraging trade gains to invest in healthcare infrastructure and services, is imperative. Targeted interventions ensuring equitable access to immunization services should also be emphasized.

Breathing together: A global hashtag analysis of #LungHealth on platform X (formerly Twitter)

Background

The X platform has gained popularity in healthcare, with posts among physicians increasing by 112% over five years. In the context of pulmonology, #LungHealth is used for engagement, spreading awareness, and disseminating information on respiratory diseases, yet its impact remains unexplored.

Objective

We aim to analyze #LungHealth by measuring outreach and quantitative engagement metrics associated with #LungHealth.

Methods

We conducted an analysis of #LungHealth posts over social media platform X (formerly Twitter) using Fedica, an analytic tool over 2 years from 1st May 2022 to 1st May 2024. This analysis studied quantitative metrics such as the number of posts, likes, views, user's geographical distribution, and co-occurring hashtags.

Results

This hashtag analysis of #LungHealth for 2 years resulted in a total of 13,824 posts. The study showed that these posts were generated by 6100 active users producing over 80 million impressions. The posts garnered 1116 replies and 19,006 likes. Geographical distribution showed the posts spanning across 105 countries. The top 10 countries with the highest number of posts were the USA, India, UK, Canada, Australia, Nigeria, Belgium, Netherlands, Switzerland, and Kenya. Common co-occurring hashtags identified were #COPD, #COVID19, #Lungcancer, and #Asthma. The top 10 influencers consisted of six Indian media outlets, one health company, one educational institution, one Arabic media outlet, and one American journalist.

Conclusion

This is the first study that provides a unique perspective on utilizing #LungHealth as a tool for global engagement in promoting lung health awareness and reaching various audiences on a global scale.

Digital health literacy and use of patient portals among Spanish-preferred patients in the United States: a cross-sectional assessment

Objective

Individuals with Limited English Proficiency (LEP), including Spanish-preferred patients, face healthcare challenges due to language barriers. Despite the potential of digital health technologies to improve access and outcomes, there is a "digital divide" with underutilization among vulnerable populations, including Spanish-speaking LEP individuals, highlighting a need for increased understanding and equitable digital health solutions.

Materials and methods

A multi-mode, multi-language cross-sectional survey was built based on the Technology Acceptance Model and deployed from a multi-state healthcare practice. Measures included patient-reported comfort level with reading and speaking English, internet and computer access and satisfaction, ability to perform healthcare-related online tasks, and the eHEALS scale of digital health literacy.

Results

A total of 212 Spanish-preferred patients completed the survey (response rate, 212/2,726 = 7.8%), of which 73.6% indicated lack of comfort in reading or writing in English (LEP n = 156). Spanish-speaking individuals with LEP reported higher rates of needing help when learning how to use new technology or devices, reporting difficulty in the evaluation of health information on the internet and being able to differentiate high-quality information from low-quality online health resources, feeling confident in using health information found online to make health decisions, and having lower access to health-related online services than Spanish-speaking individuals without LEP.

Discussion

Improving equitable accessibility to digital tools for individuals with LEP seeking healthcare can help to improve their engagement with their providers and promote self-efficacy in their care. Opportunities exist with emerging technologies to develop language-concordant healthcare resources that will improve outcomes for Spanish-preferred patients.

Perspectives of Digital Health Innovations in Low- and Middle-Income Health Care Systems From South and Southeast Asia

Digital health innovations have emerged globally as a transformative force for addressing health system challenges, particularly in resource-constrained settings. The COVID-19 pandemic underscored the critical importance of these innovations for enhancing public health. In South and Southeast Asia, a region known for its cultural diversity and complex health care landscape, digital health innovations present a dynamic interplay of challenges and opportunities. We advocate for ongoing research built into system development and an evidence-based strategy focusing on designing and scaling national digital health infrastructures combined with a vibrant ecosystem or "marketplace" of local experiments generating shared experience about what works in which settings. As the global digital health revolution unfolds, the perspectives drawn from South and Southeast Asia-including the importance of local partnerships-may provide valuable insights for shaping future strategies and informing similar initiatives in low- and middle-income countries, contributing to effective digital health strategies across diverse global health contexts.

Association Between X/Twitter and Prescribing Behavior During the COVID-19 Pandemic: Retrospective Ecological Study

BACKGROUND

Social media has become a vital tool for health care providers to quickly share information. However, its lack of content curation and expertise poses risks of misinformation and premature dissemination of unvalidated data, potentially leading to widespread harmful effects due to the rapid and large-scale spread of incorrect information.

OBJECTIVE

We aim to determine whether social media had an undue association with the prescribing behavior of hydroxychloroquine, using the COVID-19 pandemic as the setting.

METHODS

In this retrospective study, we gathered the use of hydroxychloroquine in 48 hospitals in the United States between January and December 2020. Social media data from X/Twitter was collected using Brandwatch, a commercial aggregator with access to X/Twitter's data, and focused on mentions of "hydroxychloroquine" and "Plaquenil." Tweets were categorized by sentiment (positive, negative, or neutral) using Brandwatch's sentiment analysis tool, with results classified by date. Hydroxychloroquine prescription data from the National COVID Cohort Collaborative for 2020 was used. Granger causality and linear regression models were used to examine relationships between X/Twitter mentions and prescription trends, using optimum time lags determined via vector auto-regression.

RESULTS

A total of 581,748 patients with confirmed COVID-19 were identified. The median daily number of positive COVID-19 cases was 1318.5 (IQR 1005.75-1940.3). Before the first confirmed COVID-19 case, hydroxychloroquine was prescribed at a median rate of 559 (IQR 339.25-728.25) new prescriptions per day. A day-of-the-week effect was noted in both prescriptions and case counts. During the pandemic in 2020, hydroxychloroquine prescriptions increased significantly, with a median of 685.5 (IQR 459.75-897.25) per day, representing a 22.6% rise from baseline. The peak occurred on April 2, 2020, with 3411 prescriptions, a 397.6% increase. Hydroxychloroquine mentions on X/Twitter peaked at 254,770 per day on April 5, 2020, compared to a baseline of 9124 mentions per day before January 21, 2020. During this study's period, 3,823,595 total tweets were recorded, with 10.09% (n=386,115) positive, 37.87% (n=1,448,030) negative, and 52.03% (n=1,989,450) neutral sentiments. A 1-day lag was identified as the optimal time for causal association between tweets and hydroxychloroquine prescriptions. Univariate analysis showed significant associations across all sentiment types, with the largest impact from positive tweets. Multivariate analysis revealed only neutral and negative tweets significantly affected next-day prescription rates.

CONCLUSIONS

During the first year of the COVID-19 pandemic, there was a significant association between X/Twitter mentions and the number of prescriptions of hydroxychloroquine. This study showed that X/Twitter has an association with the prescribing behavior of hydroxychloroquine. Clinicians need to be vigilant about their potential unconscious exposure to social media as a source of medical knowledge, and health systems and organizations need to be more diligent in identifying expertise, source, and quality of evidence when shared on social media platforms.

The Quality and Cultural Safety of Online Osteoarthritis Information for Affected Persons and Health Care Professionals: Content Analysis

BACKGROUND

Osteoarthritis is more prevalent and severe among women than among men, but women are less likely to access early diagnosis and first-line management, particularly racialized immigrant women. Previous research advocated for greater access to culturally safe osteoarthritis information for both diverse women and health care professionals. The internet can reduce disparities by facilitating access to health information, but online materials can vary in quality.

OBJECTIVE

This study aimed to assess the quality and cultural safety of online osteoarthritis materials for persons affected by osteoarthritis and health care professionals.

METHODS

Content analysis was used to describe publicly available materials on osteoarthritis first-line management developed by Canadian organizations for affected persons or health care professionals. Searching, screening, and data extraction were performed in triplicate. We identified materials by searching Google, MEDLINE, and references of osteoarthritis-relevant guidelines and policies, and consulting our research team and collaborators. We assessed quality using DISCERN (University of Oxford) and a compiled framework for affected persons and health care professionals. We compiled frameworks to assess cultural safety. We derived an overall score, categorized as low (<50%), moderate (50%-69%), or high (≥70%+) for criteria met.

RESULTS

After screening 176 items and eliminating 129, we included 47 osteoarthritis materials published between 2013 and 2023. Of those, 43 were for persons with osteoarthritis, most were developed by charities (n=31, 72.1%), based on expert advice (n=16, 55.2%), and in the format of booklets (n=15, 34.9%) or text on web pages (n=10, 23.3%). Of those, 23.3% (10/43) low, 46.5% (20/43) moderate, and 30.2% (13/43) high scored quality; and 25.6% (11/43), 48.8% (21/43), and 25.6% (11/43) were rated low, moderate, and high cultural safety, respectively. Of the 47 included osteoarthritis materials, 4 were for health care professionals. They were developed by a consortium (2/4, 50%), a charity (1/4, 25%), and a professional society (1/4, 25%), and largely based on expert advice (3/4, 75%). The format included infographics (3/4, 75%) and text on web pages (1/4, 25%). Of those, 25% (1/4), 25% (1/4), and 50% (2/4) were rated low, moderate, and high quality, respectively; and all were rated low for cultural safety. Quality and cultural safety did not appear to be associated with the characteristics of osteoarthritis materials (eg, type of developer, development method, and format).

CONCLUSIONS

Overall, included osteoarthritis materials for persons with osteoarthritis and health care professionals were of low to moderate quality and cultural safety. These findings reveal the need for further efforts to improve existing or develop new osteoarthritis materials for both affected persons, including ethnoculturally diverse immigrant women, and health care professionals. Further research is needed to assess the quality and cultural safety of osteoarthritis materials developed by organizations outside of Canada and to establish a framework or instrument to assess cultural safety in the osteoarthritis context.

Low-cost and convenient screening of disease using analysis of physical measurements and recordings

In recent years, there has been substantial work in low-cost medical diagnostics based on the physical manifestations of disease. This is due to advancements in data analysis techniques and classification algorithms and the increased availability of computing power through smart devices. Smartphones and their ability to interface with simple sensors such as inertial measurement units (IMUs), microphones, piezoelectric sensors, etc., or with convenient attachments such as lenses have revolutionized the ability collect medically relevant data easily. Even if the data has relatively low resolution or signal to noise ratio, newer algorithms have made it possible to identify disease with this data. Many low-cost diagnostic tools have been created in medical fields spanning from neurology to dermatology to obstetrics. These tools are particularly useful in low-resource areas where access to expensive diagnostic equipment may not be possible. The ultimate goal would be the creation of a "diagnostic toolkit" consisting of a smartphone and a set of sensors and attachments that can be used to screen for a wide set of diseases in a community healthcare setting. However, there are a few concerns that still need to be overcome in low-cost diagnostics: lack of incentives to bring these devices to market, algorithmic bias, "black box" nature of the algorithms, and data storage/transfer concerns.

From Validation to Assessment of e-Health Literacy: A Study among Higher Education Students in Portugal

Despite their familiarity with technology, higher education students often lack the critical skills needed to assess the credibility of online health information, potentially impacting their health decisions and well-being. This study aims to validate and assess the e-Health Literacy Scale among those in Portuguese higher education. In addition, this study focused on measuring their e-health literacy levels and investigating how these skills relate to different sociodemographic variables. This cross-sectional study was conducted in two phases. Initially, the test-retest reliability and reproducibility of measured e-health literacy were assessed with a convenience sample of 20 participants. Subsequently, the e-health scale was applied to a group of 245 Portuguese higher education students. The research took place from January 2023 to April 2024. The scale exhibited robust internal consistency and reproducibility. Male gender consistently correlates with higher levels of e-health literacy. Students demonstrate good levels of e-health literacy (24/40), reflecting their ability to effectively navigate and utilize health information online. By integrating strategies to further enhance this literacy into university health programs, students can develop essential skills necessary for making informed decisions about their health. This proactive approach not only empowers students to access reliable health resources but also fosters a culture of health literacy that can positively impact their well-being both during their academic journey and beyond graduation.

A systematic review of digital access to post-diagnostic health and social care services for dementia

OBJECTIVES

For many people with dementia and unpaid carers, using technology for care and support has become essential. Rapid proliferation of technology highlights the need to understand digital access to health and social care services for dementia. This mixed-methods systematic review aims to explore digital access to health and social care services for dementia, from the perspective of people with dementia and unpaid carers.

METHODS

Nine electronic databases were searched in May 2023 for qualitative, quantitative, or mixed-method studies, published in English or German, focused on experiences of using technology-delivered health and social care services for people with dementia and unpaid carers. After removal of duplicates and screening, 44 empirical papers were included.

RESULTS

From the 44 studies, findings were grouped into five categories, highlighting experiences for people with dementia and unpaid carers: (1) Adapting to technology, (2) Inequalities and variations in outcomes, (3) Impact on caring, (4) Impact on health, and (5) Impact on relationships. Proliferation of technology in care access emphasised the need for quick adaptation to technology and examination of its impact. The impact of such service delivery has evidenced mixed findings. There were improvements in the health and wellbeing of people with dementia and unpaid carers, and benefits for their dyadic relationship. However, using technology for health and social care access is not always possible and is often reliant on unpaid carers for support. Lower tech-literacy, lack of equipment or money to buy equipment and poor internet connection can impact the potential for positive outcomes.

CONCLUSIONS

Technology can bring great benefits: social inclusion, improved service access and care. However, using technology in service delivery in dementia needs careful thought. Professionals and service providers need to be cognizant of the complex nature of dementia, and the benefits and challenges of hybrid service delivery.

Understanding social needs screening and demographic data collection in primary care practices serving Maryland Medicare patients

BACKGROUND

Health outcomes are strongly impacted by social determinants of health, including social risk factors and patient demographics, due to structural inequities and discrimination. Primary care is viewed as a potential medical setting to assess and address individual health-related social needs and to collect detailed patient demographics to assess and advance health equity, but limited literature evaluates such processes.

METHODS

We conducted an analysis of cross-sectional survey data collected from n = 507 Maryland Primary Care Program (MDPCP) practices through Care Transformation Requirements (CTR) reporting in 2022. Descriptive statistics were used to summarize practice responses on social needs screening and demographic data collection. A stepwise regression analysis was conducted to determine factors predicting screening of all vs. a targeted subset of beneficiaries for unmet social needs.

RESULTS

Almost all practices (99%) reported conducting some form of social needs screening and demographic data collection. Practices reported variation in what screening tools or demographic questions were employed, frequency of screening, and how information was used. More than 75% of practices reported prioritizing transportation, food insecurity, housing instability, financial resource strain, and social isolation.

CONCLUSIONS

Within the MDPCP program there was widespread implementation of social needs screenings and demographic data collection. However, there was room for additional supports in addressing some challenging social needs and increasing detailed demographics. Further research is needed to understand any adjustments to clinical care in response to identified social needs or application of data for uses such as assessing progress towards health equity and the subsequent impact on clinical care and health outcomes.

The impact of digital skills on health: Evidence from the China General Social Survey

OBJECTIVE

The widespread penetration of the internet and digital technology have profoundly impacted the global economy and people's lives. Although the impact of digital skills on social development and personal lifestyles is well-documented, their influence on health and health inequalities remains underexplored. This study aims to analyze the impact of digital skills on health and health inequalities and to investigate the underlying mechanisms.

METHODS

This study utilized cross-sectional data from the 2017 China General Social Survey (N = 2195). We employed the Ordered Probit (O-Probit) model and ordinary least squares regression to examine the impact of digital skills on health and explore the underlying mechanisms. Health inequalities across different groups were measured using the health concentration index.

RESULTS

Enhancing digital skills enhances population health by boosting economic status, increasing social participation, and improving access to information. However, the impact varies by age and residence. Digital skills have a stronger effect on the health of young and middle-aged individuals, as well as urban residents, compared to older adults and rural populations. Furthermore, digital skills exacerbate health inequalities, benefiting high-income groups and widening the gap between income levels.

CONCLUSIONS

Widespread promotion and continuous improvement of digital skills are key to enhancing public health. We need to focus on the popularization of digital skills and the construction of digital infrastructure for low-income disadvantaged groups and rural areas, as well as use various means to reduce group and regional differences in the impact of digital skills on health conditions.

Is there a relationship between internet access and COVID-19 mortality? Evidence from Nigeria based on a spatial analysis

With over 6.5 million deaths due to COVID-19, it has become an issue of global health concern. Early findings have identified several social determinants of deaths from COVID-19. However, very few studies have been done on the relationship between internet access and COVID-19 mortality in the context of developing countries. Using geospatial methods, this study examines the relationship between internet access and COVID-19 mortality disparity in Nigeria. In contrast to the widely reported relationship in the literature that internet access lowers the risk of COVID-19 mortality, the current study finds that geographical locations with the highest internet access are the hotspots of COVID-19 mortality in Nigeria, especially some parts of southwest Nigeria. In addition, findings show that population density and unemployment are risk factors of COVID-19 mortality. The study recommends educating the population on the use of online health information and the need to adhere strictly to non-pharmaceutical and vaccination interventions to reduce the number of deaths caused by the virus.

How does digital life influence the health service use among rural residents? Evidence from China

BACKGROUND

The Healthy China strategy is an important development objective of the 14th Five-Year Plan and Vision 2035 in China, while health service use in rural China has been a weak link in this strategy.

OBJECTIVE

Nowadays, people's health service use will be influenced by digital technology due to the arrival of the Digital Age, and that is the reason why our interest is to discuss the effect of digital life on health service use among rural residents.

METHODS

We use the data from the China Family Panel Studies (CFPS) 2020 to examine the effect of digital life on health service use among rural residents, and we use Instrumental Variables method to control the endogenous problem and use KHB model to discuss the mechanism of this effect.

RESULTS

It was found that digital life has increased the health service use among rural residents significantly, and this result has been verified by robust test and Instrumental Variables method. Besides, digital life can increase health service use through the information channel effect and the health literacy effect indirectly. Moreover, digital life has a more significant impact on the residents with low social capital, low physical capital and low social trust, which represents the inclusivity of digital life.

CONCLUSION

The results of our paper will be helpful to examine the effect of the digital policy on promoting the health service use in rural China, and our findings will provide evidence of how to use digital life to enhance health service use among rural residents. Based on this, the government should take measures to eliminate the digital divide between urban and rural areas by promoting the level of digital life among rural residents, paying more attention to the digital literacy development among them, and forging ahead toward the great goal of the Healthy China under the Digital Age.

Implementation of Health Information Systems to Improve Patient Identification

Wellbeing can be ensured in society through quality healthcare, a minimum of medical errors, and the improved performance of healthcare professionals. To this end, health information systems have been implemented in hospitals, with this implementation representing progress in medicine and information technologies. As a result, life expectancy has significantly increased, standards in healthcare have been raised, and public health has improved. This progress is influenced by the process of managing healthcare organizations and information systems. While hospitals tend to adapt health information systems to reduce errors related to patient misidentification, the rise in the occurrence and recording of medical errors in Lebanon resulting from failures to correctly identify patients reveals that such measures remain insufficient due to unknown factors. This research aimed to investigate the effect of health information systems (HISs) and other factors related to work-related conditions on reductions in patient misidentification and related consequences. The empirical data were collected from 109 employees in Neioumazloum Hospital in Lebanon. The results revealed a correlation between HISs and components and the effects of other factors on patient identification. These other factors included workload, nurse fatigue, a culture of patient safety, and lack of implementation of patient identification policies. This paper provides evidence from a Lebanese hospital and paves the way for further studies aiming to explore the role of information technologies in adopting HISs for work performance and patient satisfaction. Improved care for patients can help achieve health equality, enhance healthcare delivery performance and patient safety, and decrease the numbers of medical errors.