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Expanding a Behavioral View on Digital Health Access: Drivers and Strategies to Promote Equity

Authors: Kepper MMFowler LAKusters ISDavis JWBaqer MSagui-Henson SXiao YTarfa AYi JCGibson BHeron KEAlberts NMBurgermaster MNjie-Carr VPKlesges LM


Affiliations

1 Prevention Research Center, Washington University in St. Louis, St. Louis, MO, United States.
2 Sexuality, Health, and Gender Center, Washington University in St. Louis School of Medicine, Saint Louis, MO, United States.
3 Department of Health, Human, and Biomedical Sciences, University of Houston-Clear Lake, Houston, TX, United States.
4 Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States.
5 College of Nursing, University of Central Florida, Orlando, FL, United States.
6 Neamah Health Consulting, Boston, MA, United States.
7 Clinical Strategy and Research Team, Modern Health, San Francisco, CA, United States.
8 Department of Population Health Science, Weill Cornell Medicine, Cornell University, New York, NY, United States.
9 School of Medicine, Yale University, New Haven, CT, United States.
10 Fred Hutchinson Cancer Center, Seattle, WA, United States.
11 Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States.
12 Psychology Department, Old Dominion University, Norfolk, VA, United States.
13 Virginia Consortium Program in Clinical Psychology, Norfolk, VA, United States.
14 Department of Psychology, Concordia University, Montreal, QC, Canada.
15 Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, United States.
16 Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX, United States.
17 Department of Organizational Systems and Adult Health, University of Maryland, Baltimore, MD, United States.
18 Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States.

Description

The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science-based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for a unique and comprehensive exploration of current drivers of digital health inequities. This paper aims to present a compilation of strategies that can potentially have an actionable impact on digital health equity. Multilevel factors drive unequal access, so strategies require action from tool developers, individual delivery agents, organizations, and systems to effect change. Strategies were shaped with a behavioral medicine focus as the field has a unique role in improving digital health access; arguably, all digital tools require the user (individual, provider, and health system) to change behavior by engaging with the technology to generate impact. This paper presents a model that emphasizes using multilevel strategies across design, delivery, dissemination, and sustainment stages to advance digital health access and foster health equity.


Keywords: behavioral medicinedigital dividedigital healthhealth care accesshealth equityimplementationmHealthmobile healthmobile phone


Links

PubMed: https://pubmed.ncbi.nlm.nih.gov/39088246/

DOI: 10.2196/51355