Most of us, as healthcare professionals, would consider access to the internet to be an essential part of our work, whether this is for communicating with each other or keeping up to date with our field. For patients, the benefits of access to the internet are many. Being able to contact peer-support and information about health issues encourages self-reliance, and being able to receive appointment reminders and results by text or email is the preference of some of our population; however, despite increasing access to mobile phone services, and internet connections, there is a digital divide within our population.
In the UK, 93% of adults had a mobile phone in 2013, according to Ofcom; although it not possible to break this down by social deprivation. It is also not possible to obtain statistics for PAYG versus contract plans. Our use of landlines appears to be static, with subscriptions remaining steady over the last twelve months. It is possible in the UK for those on benefits to obtain reduced landline subscriptions, and reduced rate broadband subscription on top of this via BT. Only 16% of our population live in a mobile-only home, and 77% have access to fixed or mobile (through a dongle) broadband.
In Scotland, the government published a study of internet use broken down by social deprivation in 2012. In those earning over £40,000 98% of the population have access to home internet, but in those earning less than £15,000, this drops to 50%.
A paper by published last month (online first) “Resources: A technology maintenance perspective Cell phone disconnection disrupts access to healthcare and health” by Gonzales et al and published in New Media and Society, discusses the issue of the digital divide and the effect of poverty on access to mobile phones. This small study looked at the US population, and the findings are not wholly transferrable immediately to other populations, but highlight some of the problems faced by those in poverty with regard to the availability of technology. In the US, it is possible for those on benefits to obtain government subsidised mobile phones (nicknamed “Obamaphones”) with reduced pay-as-you-go (PAYG) plans. Landline use in the US is falling, and the population appears to be increasingly reliant on mobile phone use. As demand for mobile orientated services increase, and healthcare providers choose to provide access to services via telephone or internet, this potentially excludes the population who cannot maintain connectivity.
To quote science fiction author William Gibson “The future is here, it’s just not widely distributed yet.” Those in poverty might be able to access equipment that improves their connectivity, but the it is the maintenance of this through equipment and skills that ensures continued benefit. This issue creates a secondary digital divide, with the rich, being able to access the latest technology and education to use it efficiently, gaining the most benefit and leaving the poor behind.
This invisible privilege is an important factor to consider when commissioning services through encourage patients to access information or services through the internet or mobile phones. Services through chew through data and minutes may not be as cost-effective as face-to-face meetings when access through PAYG is considered.