“Health policy makers should follow developments in telecommunications carefully,” remarked one researcher we interviewed. As so many health applications require the internet—and most perform better with broadband access—the importance of ensuring access to such technology cannot be understated. This appreciation of the importance of online connectivity is reflected in the Healthy People 2010objective calling for increased internet access in the home. Although gaps in internet and computer access have been closing in recent years, they still remain.
One strategy to address these needs is the promotion of publically available computers. Indeed public libraries do serve as an important venue from which low-income and African American children access the web. Another alternative is placing health kiosks—computer stations with software to help individuals address their health and health insurance needs—in health centers or other locations that provide health and social services. However, for privacy reasons, public computers may not be ideal for health-related purposes. Given the fact that mobile phone use is growing rapidly and is particularly popular among Hispanics, some of the experts with whom we spoke suggested that applications for mobile phones may become increasingly popular in coming years as advances are made to make such applications more feasible.
Gaining access to hardware, software, and the internet is not sufficient to assure “meaningful access” to health IT, as individuals will also need the skills to use them. Some of these necessary skills may be physical ones; one analysis of e-health tools pointed out that physical manipulation of a mouse may be challenging for some people and many sites are not accessible for individuals with visual impairments. As discussed above, cognitive skills are essential for successfully identifying usable health information.
There are three different approaches for addressing these cognitive capacity issues. First, more appropriate tools could be designed to take into account the needs of users with regard to reading level and navigation and to pay particular attention to making materials relevant and culturally competent for diverse populations. Part of the process of making materials more appropriate for users involves conducting content analysis with an eye to information quality and readability and engaging consumers to understand their perceptions of the material.
A second policy approach involves preparing individuals to be able to use applications. One interviewee discussed the potential role of health education, possibly at hospitals, in order to help consumers use online resources upon discharge.
Third, there could be a larger role for individuals using online applications on behalf of others who are less able to do so. The role could be filled by friends and family or by promotoras or other community health providers. Several caveats attach to this approach. As one of the experts pointed out, it is not clear that the family member, caregiver, or promotora is himself capable of using the online tools. Another consideration involves privacy, as captured by one anecdote relayed to us by one of our experts: an older woman relied on her grandson to look up information for her about a leg injury; however, when she needed to learn more about a “female problem” she no longer felt comfortable requesting his assistance.