This post is the last in a five-part series on disparities and digital health, including Measure What You Want to Manage, Navigate the Digital Divide, Design for Your Population’s Needs, and Speak the Right Language.
The big take away for this post is the importance of collaborating with members of the community you are trying to reach. If you go it alone, you’re much less likely to be successful!
Trust is Local
One reason to plug into the communities you want to serve is that it’s one of the best ways to address issues of trust. According to participants in a White House Summit on Achieving eHealth Equity my former office at ONC hosted with the Office of Minority Health and ZeroDivide, underserved groups of patients are more likely than other groups to distrust the healthcare system as well as online sources of health information. By communicating through a trusted community member, you can overcome concerns about whether your efforts are in fact in the group’s best interests. This is particularly important in the case of introducing digital tools, since many are relatively new and unfamiliar.
Collaborate on Multiple Levels
When you think about community engagement, it’s critical to ensure that you are seeking input from members of the community at all stages of a digital health program or initiative, not just finding sympathetic members to broadcast your message at the end. Bringing members of the community into the planning and execution process is likely to yield the most successful outcomes.
The National Center for Cultural Competence wrote a policy brief on engaging communities to eliminate health disparities more than a decade ago. While its focus wasn’t digital tools specifically, its approach is still relevant today. A key point of the brief is the importance of recognizing and supporting diversity within and among communities, as well as each community’s own capacity for making its own decisions.
Health Happens in Communities
As Silas Buchanan, who leads the Institute for eHealth Equity pointed out to me, a relatively healthy person may spend only 15 minutes per year in a doctor’s office, and more than 70 hours per year at church. Does a doctor or a preacher have a greater chance of influencing that person’s health behaviors, particularly when it comes to the critically important everyday activities (eating, moving, socializing) that contribute to at least 40% of overall wellness? Sheer level of exposure tips the scales in favor of the preacher, particularly if advice relates to a behavior that can be put into practice in the immediate term, such as walking more or selecting healthier options at a grocery store.
As former Surgeon General Regina Benjamin puts it, “Healthcare doesn't just occur in our doctors' offices and our hospitals. It occurs in everything we do. It occurs where we live, where we work, where we play, and where we pray.” By engaging the community, we’re increasing awareness of digital tools at the most relevant times.
Text4Wellness is an mHealth service that provides timely, actionable information on healthy lifestyles, prevention, and general wellness, especially targeted toward underserved communities. It provides culturally tailored and actionable messaging, and is positioned as a community service, driven by the Pastor from the pulpit and by other trusted community leaders.
Spotlight: Million Hearts
MillionHearts is a federally led national initiative with a goal of preventing 1 million heart attacks and strokes by 2017. Among its aims are “activating the public to lead a heart-healthy lifestyle,” and improving medication adherence, which it does in part through partnerships with congregations and faith-based organizations across the country and by leveraging tools such as texting.
Though some fear that digital technologies will exacerbate health disparities, I believe we should acknowledge the risks but also pursue the promising opportunities digital health offers for closing the gap. Technology is never a panacea—what’s always most important is how it’s used. In this series we’ve explored several dimensions of using it well, including measuring what you want to manage, navigating the digital divide, designing for your population’s needs, and speaking the right language.
In wrapping up this series I want to point you toward a great new resource from the California Health Care Foundation – Digitizing the Safety Net: Health Tech Opportunities for the Underserved, which provides numerous examples of specific digital tools in use today. It’s great to see more efforts devoted to this theme, and my hope is that the trend will continue as the shift from volume-based to value-based payment in healthcare leads to better design and application of digital health tools—for all populations.
Have you effectively engaged an underserved community using digital health tools? How? Are there any key concepts or approaches missing from this blog series? Please share your thoughts and experience!