Digital technology use among disadvantaged Australians: implications for equitable consumer participation in digitally-mediated communication and information exchange with health services
Australian Health Review
Objective: To present research findings on access to, and use of, digital information and communication technologies (ICTs) by Australians from lower income and disadvantaged backgrounds to determine implications for equitable consumer access to digitally-mediated health services and information. Methods: Focus groups were held in 2008-2009 with 80 residents from lower income and disadvantaged backgrounds in South Australia, predominantly of working-and family-formation age (25 to 55).
... 25 to 55). Qualitative analysis was conducted on a-priori and emergent themes to describe dominant categories. Results: Access to, and use of, computers, the Internet and mobile phones varied considerably in extent, frequency and quality within and across groups due to differences in abilities, resources and lifecourse pathways. Barriers and facilitators included English literacy situation, social connection, health status, employment status, and trust. Many people gained ICT skills by trial and error or help from friends, and only a few from formal programs, resulting in varied skills. Conclusion: The considerable variation in ICT access and use within lower income and disadvantaged groups must be acknowledged and accommodated by health initiatives and services when delivering digitally-mediated consumer-provider interaction, online health information, or online self-management of health conditions. If services require consumers to participate in digitally-mediated communication exchange, then we suggest they might support skills and technology acquisition, and/or provide non-ICT alternatives, in order to avoid exacerbating health inequities. What is known about the topic? Government and health provider use of digitally-mediated information and communication is rapidly increasing. However, national data show that ICT access is unevenly distributed across Australia's population. Furthermore, this distribution mirrors the health gradient. There is little qualitative data on the extent to which, and ways in which, ICTs are used within lower income and disadvantaged groups -those with greater health need. What does this paper add? This paper augments the scant literature to describe ICT access and use in a range of lower income and disadvantaged groups. It indicates barriers and facilitators , and highlights the need for formal supports to level up the whole population to have the skills, confidence and resources to use and benefit from ICT-mediated communication. What are the implications for practitioners? As health services and governments increase the level of digitally-mediated information and communication connection with consumers/patients, it is important to understand and find ways to address differential consumer access to and use of ICTs, so that equity of access to services and information is promoted. This is particularly important as lower income and disadvantaged groups are likely to have both poorer health and lower ICT use. Archived at Flinders University: dspace.flinders.edu.au Conclusion Our study findings augment the scant literature to provide insight into the implications of increased ICT-mediated health services for disadvantaged groups. While qualitative findings from non-random selected groups are not generalisable, this limitation was partly addressed by our participants having broadly representative characteristics of the more disadvantaged in the Australian population. Our study suggests that ICT mediated health initiatives should be considered in more complex and diverse ways to ensure that health inequities are not exacerbated by digitally-mediated communication methods excluding those who lack skills, resources or capabilities to use ICTs. Unless lower SES groups receive appropriate support (e.g. skills training, funded equipment), ICT mediated communication may become a new barrier to health service access. Consumers should be included in communication planning, rather than taking a "one-size-fits-all" approach, and further research on the topic is indicated. Without such compensatory measures Australia's E-Health Strategy may end up increasing inequities in health service access.