The Digital Divide in Health Education: Myth or Reality?
Stellefson, Michael, Chaney, Beth, Chaney, Don, American Journal of Health Education
Although e-health interventions provide new opportunities for health education, there has been cause for concern regarding the purported information technology gap between those who have access to digital applications and those who do not--termed the "digital divide." The literature suggests, however, that this divide may now be illusory, driven primarily by a myriad of societal divides such as income, education, and literacy inequities. Such disparities may be the true propagators of what is now becoming a mythical digital divide. The purpose of this article is to identify the evolutionary nature of the digital divide and speculate as to how and why it has become a mirage in today's increasingly technological world. Based on this discussion, suggestions are made regarding how health educators can enable the use of technology to better health through the study of consumer health informatics and e-health behavioral support.
Rapidly evolving technology has given researchers and practitioners in health education opportunities to create innovative interventions that were not possible before the birth of the digital age. Web-based interventions have proven particularly useful, as the use of the internet as a communication device has proliferated with time. As reported by Miller and West, (1) the number of Americans using the internet for health care has nearly doubled since 2000, making a significant impact on the health care process. (2) The internet and computer technology are resources that guide health education and have the potential to enhance patient decision-making and self management of pre-existing health conditions. (3) In fact, the U.S. Department of Health and Human Services recognizes the potential of the internet and specifically addressed its use within Healthy People 2010. Priority area 11 of that document specifically made reference to internet access in the home, quality of health education internet resources, and design, implementation, and evaluation of technology-delivered health communication interventions. (4)
Although technology-mediated interventions provide new avenues for health information dissemination and health service delivery, there has been cause for concern that an information gap may exist between those who have access to digital technology and those who do not--referred to as the "digital divide." To limit this divide, health education researchers and practitioners have been called on to advocate increased functional access to the internet and recognize digital inclusion as a requisite aspect of physical, social, and mental health. (5,6) Although enhanced digital access may be integral for sustaining the future of technology in health education, access alone may not expand an individual's exposure to health information on the internet. Rather, digital access and digital retrieval skills are both necessary to enhance health information processing. (7) Because of this, health educators interested in technology applications are directed to "start where the people are" in terms of health knowledge and technological expertise "in order to help them access information technology in a manner that is appropriate, effective and respectful of their individual and collective needs and perspectives." (5(p528)) Thus, a formative step in developing technology-based health interventions is enabling individuals to access health information transmitted through technology--not simply providing access to technological resources. (8)
The discussion of digital inclusion as it relates to health informatics begs the question: Does the digital divide (as characterized above) act as the underlying reality propagating inequities related to health information technology access? A number of technology initiatives were enacted in the late 1990s to help eliminate the digital divide, and they were deemed successful. (9) Indeed, as a result of these initiatives and others, (10) it has been suggested that the difference in technology access and usage among underserved segments of the population is beginning to narrow. …