Exploring access to, use of and benefits from population-oriented digital health services in Australia.

The provision of population-oriented, on-demand digital health services in many countries exemplifies the perceived utility of digital health services in supporting population health. Yet, limited knowledge exists regarding the equity of these services. Using mixed-method research, we recruited users of a health website and general practice patients to surveys (n = 441) and telephone interviews (n = 40). We contribute specific evidence investigating barriers to access, use and benefit from digital health services within an equity framework that incorporates social determinant factors, eHealth Literacy and trust. Our research highlights the foundational role of trust in predicting use, showcases which groups are unlikely to benefit from population-oriented digital health services, and proposes strategies to enhance the equity of these services. The theoretical framework we developed serves as a roadmap for future health promotion research and action by outlining the complex and interrelated pathways that can promote and threaten digital health equity.

[1]  R. Osborne,et al.  Applying the Electronic Health Literacy Lens: Systematic Review of Electronic Health Interventions Targeted at Socially Disadvantaged Groups , 2020, Journal of medical Internet research.

[2]  Elisabeth Beaunoyer,et al.  COVID-19 and digital inequalities: Reciprocal impacts and mitigation strategies , 2020, Computers in Human Behavior.

[3]  S. Broucke Why health promotion matters to the COVID-19 pandemic, and vice versa. , 2020 .

[4]  J. Judd,et al.  COVID‐19: Vulnerability and the power of privilege in a pandemic , 2020, Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals.

[5]  Khorshed Alam,et al.  Determinants of access to eHealth services in regional Australia , 2019, Int. J. Medical Informatics.

[6]  F. Baum,et al.  Healthy infrastructure: Australian National Broadband Network policy implementation and its importance to health equity , 2019 .

[7]  C. Lawson,et al.  Preferences and trust in traditional and non-traditional sources of health information – a study of middle to older aged Australian adults , 2019, Journal of Communication in Healthcare.

[8]  I. Kickbusch Health promotion 4.0. , 2019, Health promotion international.

[9]  R. Osborne,et al.  Development of the Multidimensional Readiness and Enablement Index for Health Technology (READHY) Tool to Measure Individuals’ Health Technology Readiness: Initial Testing in a Cancer Rehabilitation Setting , 2019, Journal of medical Internet research.

[10]  F. Baum,et al.  Digital Infrastructure as a Determinant of Health Equity: An Australian Case Study of the Implementation of the National Broadband Network , 2018 .

[11]  P. Ward Trust , 2018, Emotions, Everyday Life and Sociology.

[12]  Peter Bragge,et al.  Digital Inclusion & Health Communication: A Rapid Review of Literature , 2018, Health communication.

[13]  Andrew Sixsmith,et al.  Exploring Privilege in the Digital Divide: Implications for Theory, Policy, and Practice , 2018, The Gerontologist.

[14]  Steinar Krokstad,et al.  Innovative technologies and social inequalities in health: A scoping review of the literature , 2018, PloS one.

[15]  P. Ward To trust or not to trust (in doctors)? That is the question , 2018, Archives of Disease in Childhood.

[16]  R. Osborne,et al.  A Multidimensional Tool Based on the eHealth Literacy Framework: Development and Initial Validity Testing of the eHealth Literacy Questionnaire (eHLQ) , 2018, Journal of medical Internet research.

[17]  Christine Hamel,et al.  Social Health Inequalities and eHealth: A Literature Review With Qualitative Synthesis of Theoretical and Empirical Studies , 2017, Journal of medical Internet research.

[18]  P. Ward,et al.  Improving Access to, Use of, and Outcomes from Public Health Programs: The Importance of Building and Maintaining Trust with Patients/Clients , 2017, Front. Public Health.

[19]  P. Ward,et al.  Predictors and Extent of Institutional Trust in Government, Banks, the Media and Religious Organisations: Evidence from Cross-Sectional Surveys in Six Asia-Pacific Countries , 2016, PloS one.

[20]  Zachary Munn,et al.  Access to primary health care services for Indigenous peoples: A framework synthesis , 2016, International Journal for Equity in Health.

[21]  Lars Kayser,et al.  The e-health literacy framework: A conceptual framework for characterizing e-health users and their interaction with e-health systems , 2015 .

[22]  P. Ward,et al.  Institutional (mis)trust in colorectal cancer screening: a qualitative study with Greek, Iranian, Anglo‐Australian and Indigenous groups , 2015, Health expectations : an international journal of public participation in health care and health policy.

[23]  P. Ward,et al.  Trust, choice and obligation: a qualitative study of enablers of colorectal cancer screening in South Australia. , 2015, Sociology of health & illness.

[24]  Gustavo S. Mesch,et al.  Digital inequalities and why they matter , 2015 .

[25]  Wen-Ying Sylvia Chou,et al.  Predictors of eHealth Usage: Insights on The Digital Divide From the Health Information National Trends Survey 2012 , 2014, Journal of medical Internet research.

[26]  A. Miah,et al.  Understanding Digital Health as Public Pedagogy: A Critical Framework , 2014 .

[27]  Fran Baum,et al.  Vicious cycles: digital technologies and determinants of health in Australia. , 2014, Health promotion international.

[28]  D. Lupton The digitally engaged patient: Self-monitoring and self-care in the digital health era , 2013 .

[29]  Grant Russell,et al.  Patient-centred access to health care: conceptualising access at the interface of health systems and populations , 2013, International Journal for Equity in Health.

[30]  Anne W. Taylor,et al.  Demographic indicators of trust in federal, state and local government: implications for Australian health policy makers. , 2013, Australian health review : a publication of the Australian Hospital Association.

[31]  Fran Baum,et al.  Digital Technology Access and Use among Socially and Economically Disadvantaged Groups in South Australia , 2010, J. Community Informatics.

[32]  Pierre Chauvin,et al.  Health information seeking on the Internet: a double divide? Results from a representative survey in the Paris metropolitan area, France, 2005–2006 , 2008, BMC public health.

[33]  D. Mcintyre,et al.  Exploring the dimensions of access. , 2007 .

[34]  David R. Jones,et al.  Synthesising qualitative and quantitative evidence: A review of possible methods , 2005 .

[35]  Mark Warschauer,et al.  Demystifying the digital divide. , 2003, Scientific American.

[36]  M. Hardey Doctor in the house: the Internet as a source of lay health knowledge and the challenge to expertise , 1999 .

[37]  Nicholas R. Hardiker,et al.  Factors that influence public engagement with eHealth: A literature review , 2011, Int. J. Medical Informatics.

[38]  P. Ward,et al.  Use of information and communication technology to provide health information: what do older migrants know, and what do they need to know? , 2010, Quality in primary care.

[39]  Jacob Cohen QUANTITATIVE METHODS IN PSYCHOLOGY A Power Primer , 1992 .

[40]  R. Andersen,et al.  A framework for the study of access to medical care. , 1974, Health services research.