How Divisive Is The Digital Divide?

By: Anna Gaudio, VP, Experience Strategy Director at McCann Health New York

With the proliferation of telehealth and remote monitoring solutions, the reality of broadband being a social determinant of health (SDOH) has come to the forefront of discussion. Because in between the possibilities of digital health solutions and the end user exists a tremendous tension: access.

It leaves us wondering if digital health solutions are really solutions if they’re not accessible to the individuals they are designed to treat. And this leads to the greater question: Are we designing for the disease or are we designing for the human?

First, let’s talk about digital inequality

For the sake of this conversation, let’s isolate digital fluency apart from the interrelated constellation of SDOH and just consider digital fluency as “the ability to access, manage, understand, integrate, communicate, evaluate, and create information safely and appropriately through digital technologies.” [1]

Here’s the quick reality check:

Digital access

Nearly 30 million Americans do not have access to high-speed internet, including 35% of people who live in rural areas [2]
One in four Americans does not have the broadband internet access (BIA) or devices needed to engage in video visits [3]

Digital fluency

At least 31.8 million American adults aren’t digitally literate [1]
Among those 16-65, the highest rate of digital illiteracy is among those 55-65 at 28% [4]

Unsurprisingly, the cohort that is responsible for the most health system utilization[5] is also the least digitally fluent. So when we propose that this population make use of telehealth systems and remote monitoring and digital adherence solutions, we’re making assumption that no efficiency, accuracy, or safety would be sacrificed. Otherwise, the technology we introduce is merely a monument commemorating health disparity.

That brings us to our approach to digital health

As a firm believer in the value of digital strategies within healthcare delivery, I don’t view this humbling reality check as a cease and desist order. Instead, I believe it issues a call for creativity. We have a trifecta of a challenge: a population with inequivalent access to digital tools and insufficient knowledge to utilize them properly, a culture that’s operationalizing digital-first solutions at a rapid pace, and a burdened healthcare system that cannot adequately support individual digital up-skilling.

So from a very realistic and tangible perspective, what responsibilities does a brand owner have to overcome the challenges at hand? I’d love to hear your thoughts because I certainly don’t have an exhaustive plan of action. What I do have are starting principles that can aid in ideating and evaluating digitally fluent solutions.

Intuitive design demands fluff removal. (That may not be the language Google uses, but I’ve taken some liberties). It’s non-disruptive. It’s simple. It’s intrinsic integration of wayfinding devices to facilitate user-centric action items. It’s understanding without conscious thought. This may mean forfeiting the visual branding elements and features that we creative marketers love. It may mean that CTAs are more easy-to-find than sleek. It may mean that we don’t need to adopt every #designtrend when developing solutions for our customers. It may mean we rethink our approach to information architecture and content mapping. Most importantly, it may mean over-weighting digital fluency evaluation criteria during user testing.
Community-based solutions offer a return to the humanity of health. Where, in the past, we perhaps over-indexed in using digital health tools to enable self-management, we now have an opportunity to use the same tools to foster group engagement and community development. Not only are peers the most trusted source of information, they also offer the support systems required to impact holistic health experiences. When we approach support tools and resources, are we thinking about how to ensure product retention and adherence, or how to surround our customers with support to better manage their disease? Are we looking at the individual or the constellation of care providers? Are we thinking about how to best activate the power of the collective? As an added marketing bonus, reconsidering our approach to these questions can promise increased efficiency in scale and influence.
Platform scale isn’t just ensuring functionality across iOS and Android devices. Inclusive platform scaling is utilization of low- and high-tech enabled solutions that don’t forfeit functionality dependent on delivery mechanism. Perhaps this comes as community hubs that serve as access points for specialized care, not relying on broadband access or digital acumen at the individual level. Or perhaps, when possible, audio-only telehealth appointments are offered to alleviate connection issues. Ideally, we may get to a point where providers guarantee low-cost devices as part of care delivery, but in the meantime, subscription-based telemedicine services may demonstrate improved digital fluency through consistency.

Just as education can serve as the great equalizer, so can technology open a door to greater health access not yet realized. But without scalable, inclusive methodologies woven into the fabric of development, the very tools meant to deliver better health will ultimately widen the gap between care and consumers. By addressing digital inequity and fluency, we can begin to bridge that precarious gap and realize the true value of a digitally-enabled, healthier future.

[1] http://uis.unesco.org/sites/default/files/documents/ip51-global-framework-reference-digital-literacy-skills-2018-en.pdf

[2] https://www.mmm-online.com/home/channel/features/the-new-digital-divide/

[3] https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2020.305784?journalCode=ajph

[4] https://nces.ed.gov/pubs2018/2018161.pdf

[5] https://www.harvardpilgrim.org/hapiguide/generation-employee-benefits/