Academic journal article Australian Health Review

Digital Technology Use among Disadvantaged Australians: Implications for Equitable Consumer Participation in Digitally-Mediated Communication and Information Exchange with Health Services

Academic journal article Australian Health Review

Digital Technology Use among Disadvantaged Australians: Implications for Equitable Consumer Participation in Digitally-Mediated Communication and Information Exchange with Health Services

Article excerpt

Introduction

The ability to access information and communication technologies (ICTs), particularly via the Internet and mobile phones, is increasingly vital to full participation in economic, social, and political life.1-4 This is particularly so as institutions move towards greater ICT-mediated provision of services, support and information.5 There is also increasing focus on encouraging digitally-mediated consumer-to-provider and consumer-to-consumer connection in the health sector (within 'e-health'), and more recently through 'm-health' (via mobile devices, including mobile phones).6

The spread of ICTs hides the uneven distribution of digital access across Australia's population, for example~28%of households have nohomeInternet access,7 although82%of Australians aged 14 years or older use a mobile phone and 31% of children aged 5-14 years own one.8,9 Socioeconomic factors influence these distributions. For example, only around 7% of households earning $120 000 or more are without home Internet, whereas 42% of households earning less than $40 000 are without home Internet.7 Similar inequities are evident by geographic area.10 However, connection data do not explain the extent to which ICTs are actually used and how this may, in turn, influence health.

Australia's National E-Health Strategy intends to 'transform the way healthcare professionals practice and consumers interact with the health system', to 'reduce costs and demands on the health system'.11 The Strategy aims to 'empower consumers' by encouraging 'electronic access to the information needed to better manage and control their personal health outcomes', and to focus on 'those segments of the population that interact frequently with the health system'.11 However, the Strategy does not acknowledge that those more likely to interact with the health system are those lower down the social gradient12 with less means to use ICTs.

In Australia, there is little qualitative research exploring digital access and use (or non-use) among lower socioeconomic status (SES) groups, or considering the implications for equitable consumer access to digitally-mediated health services. Much research on e-health is technically or provider-focussed, with an excessive focus on 'new and exciting opportunities to empower individuals' (e.g. through electronic health records)13,14 without explaining how benefits will result. Indeed, more critical approaches find potential for increased discrimination and inequality, 15 as digital inequalities are intertwined with other inequalities, such as poverty and remoteness, and parallel the uneven distribution of chronic disease.16-18 Furthermore, some assume that all consumers are abandoning traditional media channels14 and that the Internet enables 'unfettered access' to information for all.19 However, the small amount of research on non-users finds those with lower education and income being least likely to have access, for example, to Internet-based medical information and support.20-22 The next sections outline our methods and findings on ICT use, perceived barriers and facilitators, and preferences for provider contact in lower income and disadvantaged groups in South Australia. This is followed by discussion of how policy and services can support more equitable access through e-health and m-health.

Methods

Our study is a primary analysis of data from 80 individuals in nine focus groups. Between August and November 2008, six groups were held across Adelaide with 55 participants exploring ICT use, and in November 2009, three groups were held with 30 participants about Internet access via mobile phones. Focus groups are valuable for research with lower SES or 'vulnerable' populations because they give 'voice' to the participants, allowing them to define what is important to understand their experiences.23 Local service workers provided recruitment assistance in lower SES areas, as per Glover et al. and Australian Bureau of Statistics. …

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