As ubiquitous as access to technology may seem, our nation faces a formidable digital divide, which limits access to services and information for diverse communities across the country. There is a clear gap in the accessibility, relevance and trust of digital health platforms that must be closed to improve health equity.
Black, Hispanic, and low-income communities are most affected by this divide, limiting the reach and benefit of telemedicine offerings. According to a recent Pew Research survey, 82% of white respondents owned a desktop or laptop computer compared with 58% of Black respondents and 57% of Hispanics. This is alarming for myriad reasons, among them the fact that more than half of Americans claimed that the internet has been essential during the COVID-19 outbreak. Indeed, it’s an internet- and mobile-first world, yet healthcare has been slow to embrace it.
There are long-term efforts underway to narrow the divide, including opening WiFi hotspots and extending broadband infrastructure, but in the meantime, how can we reach people outside of the health facility who do not have broadband? Approaches must go beyond broadband and more deeply connect providers and patients so that those who are traditionally underserved can readily access the information and services that they need.
Sometimes innovation is about simplicity. Leveraging more foundational technology and communication channels enables access to a much wider swath of Americans. Leading hospitals, health plans and healthcare organizations are going back to the fundamentals of communication: short message service, better known as SMS. This widely adopted technology helps bridge the digital divide since a high number of Americans own a cell phone. According to the Pew Research Center, as of June 2019, 96% of Americans owned a cellphone of some variety while only 81% owned smartphones. This digital divide is formidable when you consider that the 15% without smartphones are unable to utilize features such as applications, online booking and video telehealth calls, to name a few. Yet they do have access to SMS services.
Now more than ever, there is a need for fast, clear and consistent communication from trusted healthcare entities directly to patients, particularly those at high risk of COVID-19 and other health conditions. In the era of flashy downloadable apps and browser-based patient portals, the importance of reach and accessibility often can get lost. Not engaging nearly all patients via SMS comes at a great detriment to those with limited income and access to broadband or smartphones.
The communication channel is just one part of improving accessibility. It is equally important to incorporate the right message for each individual. It is not enough to send out a mass text; different people have different needs, behaviors, beliefs and motivations. The key is to address patient populations in a way that speaks to them personally, maximizing engagement and ultimately nudging behaviors.
It is important to consider what the rise in health technologies will mean in the context of health equity. Which digital innovations will benefit those who already have access and further deepen the divide? And which ones will reach vulnerable populations that can greatly benefit from access and engagement? How can we ensure that even the hard to reach can participate and benefit from health information and services? When there are barriers, including lack of trust, how can SMS engagement be the gateway to the adoption of other digital health innovations?