CommentaryHealth Disparities, Communication Inequalities, and eHealth
Introduction
Advances in communication and computer technologies have revolutionized the way that health information is gathered, disseminated, and used by healthcare providers, patients, citizens, and mass media, leading to the emergence of a new field and new language captured in the term “eHealth.” As exciting as these technologic changes are, they have led to sometimes overly optimistic prognostications about what eHealth can do to improve the health of patients and the public and the quality of care available from providers. While conceding the significant advantages bestowed by the technologic developments and their adoption into the healthcare system, we contend that without careful and systematic research and policy, eHealth may work primarily to the advantage of individuals and communities with greater resources and the healthcare systems that serve them. This could have the effect of deepening disparities in health status among population subgroups.
There are significant challenges that must be addressed by the research community to ensure that advances in eHealth will help eliminate, not exacerbate, health disparities. These include identifying and clearly articulating specific disparity issues that affect various domains of eHealth, enhancing survey sampling and measurement in eHealth research to better understand and address disparities, and critically examining eHealth and communication-related policies that may affect health disparities.
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Disparity Issues Across eHealth Domains
For some eHealth researchers, the focus is on hardware such as the Internet and telecommunication technologies. For others, the focus is on software and content such as online support groups and provision of information on defined health topics. Addressing health disparities presents important but different challenges and key research questions for each group.
If the focus is on hardware and using eHealth as a means of information delivery and exchange among people and systems, then we must
Methodologic Challenges
New communication technologies can offer significant advantages in data collection. The Internet, for example, is now being widely used to conduct surveys. Online surveys allow considerable flexibility in data collection, obtaining large samples quickly, and relative simplicity in conducting experiments using diverse stimuli. Use of the Internet as a survey tool and the challenges associated with it has been extensively discussed elsewhere in this issue. The challenges are particularly critical
Policy Considerations in eHealth and Health Disparities
Compared to individual-level behavioral interventions, policy- and system-level interventions often have a greater impact on population health. In health disparities research, structural adjustments are often necessary to remove system barriers that impede or constrain health-promoting behaviors among socioeconomically disadvantaged populations. Research examining eHealth–related policies as they affect health disparities is sorely needed. We must understand the extent to which current
Conclusion
Our argument is not that eHealth is undesirable but rather that a systematic and focused approach to research and application of findings in policy and practice is needed to ensure that exciting and promising developments in eHealth benefit all members of society. We are at the cusp of a new era in communication and health where conventional assumptions are being upended by fast-changing technologies. We believe that thoughtful and responsible “eHealth” research can contribute to eliminating
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