Telehealth Inequity and Youth Engagement: A Mixed Methods Study of Access, Literacy, and Culture
DOI:
https://doi.org/10.61978/communica.v2i2.766Keywords:
Telemedicine, Rural Youth, Digital Literacy, Healthcare Access, Developing Regions, Digital Equity, Cultural BarriersAbstract
Telemedicine is increasingly promoted to reduce healthcare disparities in rural regions, yet rural youth remain underserved by digital health innovations. This mixed methods study combined national survey data from Hungary and Sub-Saharan Africa (n = 3,240 adolescents) with 46 in-depth interviews and 12 focus groups in Southeast Asia to examine infrastructural, educational, economic, and cultural barriers to telemedicine adoption. Results showed that fewer than 50% of rural households in Sub-Saharan Africa had stable electricity and only 24% reported internet access, compared to 88% and 62% respectively in rural Hungary. Device ownership was also limited, with just 18% of rural Sub-Saharan youth owning smartphones. Digital health literacy scores were significantly lower among rural adolescents, while cultural preferences for traditional medicine and skepticism toward digital platforms further reduced uptake. Economic constraints, particularly the cost of mobile data, posed additional barriers. Ethical issues around privacy and consent were critical, especially for minors. These findings highlight the need for affordable infrastructure expansion, school-based digital literacy programs, and culturally sensitive outreach. The study concludes that telemedicine can transform rural healthcare access if implemented through equitable infrastructure investment, inclusive education, and participatory, youth-centered policy design.
References
Al‐Samarraie, H., Ghazal, S., Alzahrani, A. I., & Moody, L. (2020). Telemedicine in Middle Eastern Countries: Progress, Barriers, and Policy Recommendations. International Journal of Medical Informatics, 141, 104232. https://doi.org/10.1016/j.ijmedinf.2020.104232 DOI: https://doi.org/10.1016/j.ijmedinf.2020.104232
Arora, S., Ryals, C. A., Rodriguez, J. A., Byers, E., & Clewett, E. R. (2022). Leveraging Digital Technology to Reduce Cancer Care Inequities. American Society of Clinical Oncology Educational Book, 42, 559–566. https://doi.org/10.1200/edbk_350151 DOI: https://doi.org/10.1200/EDBK_350151
Babatunde, A. O., Abdulazeez, A. O., Adeyemo, E. A., Uche-Orji, C., & Saliyu, A. A. (2021). Telemedicine in Low and Middle Income Countries: Closing or Widening the Health Inequalities Gap? European Journal of Environment and Public Health, 5(2), em0075. https://doi.org/10.21601/ejeph/10777 DOI: https://doi.org/10.21601/ejeph/10777
Barbic, S., Leon, A., Manion, I., Irving, S., Zivanovic, R., Jenkins, E., Ben‐David, S., Azar, P., Salmon, A., Helps, C. E., Gillingham, S., Beaulieu, T., Pattison, R., Talon, C., Oyedele, O. A., Tee, K., & Mathias, S. (2019). Understanding the Mental Health and Recovery Needs of Canadian Youth With Mental Health Disorders: A Strategy for Patient-Oriented Research (SPOR) Collaboration Protocol. International Journal of Mental Health Systems, 13(1). https://doi.org/10.1186/s13033-019-0264-0 DOI: https://doi.org/10.1186/s13033-019-0264-0
Bayat, M., & Naderi, R. (2021). Analyzing the Impact of Educational Innovations on Enhancing Motivation and Academic Enthusiasm Among Students in Rural Schools in Iran. Jsied, 1(1), 13–21. https://doi.org/10.61838/jsied.1.1.2 DOI: https://doi.org/10.61838/jsied.1.1.2
Blake, H., Adams, E. J., Chaplin, W. J., Morris, L., Mahmood, I., Taylor, M. G., Langmack, G., Jones, L., Miller, J. P., & Coffey, F. (2023). Alcohol Prevention in Urgent and Emergency Care (APUEC): Development and Evaluation of Workforce Digital Training on Screening, Brief Intervention, and Referral for Treatment. International Journal of Environmental Research and Public Health, 20(22), 7028. https://doi.org/10.3390/ijerph20227028 DOI: https://doi.org/10.3390/ijerph20227028
Brehon, K., Miciak, M., Hung, P., Chen, S., Perreault, K., Hudon, A., Wieler, M., Hunter, S., Hoddinott, L., Hall, M., Churchill, K., Brown, D. A., Brown, C. A., Bostick, G., Skolnik, K., Lam, G. Y., Weatherald, J., & Gross, D. P. (2023). “None of Us Are Lying”: An Interpretive Description of the Search for Legitimacy and the Journey to Access Quality Health Services by Individuals Living With Long COVID. https://doi.org/10.21203/rs.3.rs-2439944/v1 DOI: https://doi.org/10.21203/rs.3.rs-2439944/v1
Carolan, S., & Visser, R. d. (2018). Employees’ Perspectives on the Facilitators and Barriers to Engaging With Digital Mental Health Interventions in the Workplace: Qualitative Study. Jmir Mental Health, 5(1), e8. https://doi.org/10.2196/mental.9146 DOI: https://doi.org/10.2196/mental.9146
Chapman, A. L. N., Hadfield, M., & Chapman, C. (2015). Qualitative Research in Healthcare: An Introduction to Grounded Theory Using Thematic Analysis. The Journal of the Royal College of Physicians of Edinburgh, 45(3), 201–205. https://doi.org/10.4997/jrcpe.2015.305 DOI: https://doi.org/10.4997/jrcpe.2015.305
Cho, O., & Cho, J. (2023). Changed Digital Technology Perceptions and Influencing Factors Among Older Adults During the COVID-19 Pandemic. Healthcare, 11(15), 2146. https://doi.org/10.3390/healthcare11152146 DOI: https://doi.org/10.3390/healthcare11152146
Choi, N. G., DiNitto, D. M., Marti, C. N., & Choi, B. Y. (2021). Telehealth Use Among Older Adults During COVID-19: Associations With Sociodemographic and Health Characteristics, Technology Device Ownership, and Technology Learning. Journal of Applied Gerontology, 41(3), 600–609. https://doi.org/10.1177/07334648211047347 DOI: https://doi.org/10.1177/07334648211047347
Chowdhury, S. R., Sunna, T. C., & Ahmed, S. (2020). Telemedicine Is an Important Aspect of Healthcare Services Amid COVID‐19 Outbreak: Its Barriers in Bangladesh and Strategies to Overcome. The International Journal of Health Planning and Management, 36(1), 4–12. https://doi.org/10.1002/hpm.3064 DOI: https://doi.org/10.1002/hpm.3064
Coley, N., Andre, L., Hoevenaar‐Blom, M. P., Ngandu, T., Beishuizen, C., Barbera, M., Wanrooij, L. L. v., Kivipelto, M., Soininen, H., Gool, W. A. v., Brayne, C., Eric P. Moll van Charante, Richard, E., & Andrieu, S. (2022). Factors Predicting Engagement of Older Adults With a Coach-Supported eHealth Intervention Promoting Lifestyle Change and Associations Between Engagement and Changes in Cardiovascular and Dementia Risk: Secondary Analysis of an 18-Month Multinational Randomized Controlled Trial. Journal of Medical Internet Research, 24(5), e32006. https://doi.org/10.2196/32006 DOI: https://doi.org/10.2196/32006
Delavar, A., Saseendrakumar, B. R., Weinreb, R. N., & Baxter, S. L. (2022). Healthcare Access and Utilization Among Glaucoma Patients in a Nationwide Cohort. Journal of Glaucoma, 32(1), 40–47. https://doi.org/10.1097/ijg.0000000000002123 DOI: https://doi.org/10.1097/IJG.0000000000002123
Díez, D. l. T. (2018). What Is the Evolution of Telemedicine and E-Health in North Africa? A Systematic Review. Trends in Telemedicine & E-Health, 1(2). https://doi.org/10.31031/tteh.2018.01.000510 DOI: https://doi.org/10.31031/TTEH.2018.01.000510
Ding, X., Wuerth, K., Sakakibara, B. M., Schmidt, J., Parde, N., Holsti, L., & Barbic, S. (2023). Understanding Mobile Health and Youth Mental Health: Scoping Review. Jmir Mhealth and Uhealth, 11, e44951. https://doi.org/10.2196/44951 DOI: https://doi.org/10.2196/44951
Domoff, S. E., Borgen, A. L., Foley, R. P., & Maffett, A. (2019). Excessive Use of Mobile Devices and Children’s Physical Health. Human Behavior and Emerging Technologies, 1(2), 169–175. https://doi.org/10.1002/hbe2.145 DOI: https://doi.org/10.1002/hbe2.145
Egbewande, O. M., Oladipo, H. J., Olowolagba, S. A., & Iyiola, K. H. (2023). Application of Telemedicine in the Provision of Healthcare in Nigeria: An Insight From COVID-19. Journal of Health Reports and Technology, 9(1). https://doi.org/10.5812/jhrt-130916 DOI: https://doi.org/10.5812/jhrt-130916
Ekwegh, T., Cobb, S., Adinkrah, E., Vargas, R., Kibe, L. W., Sánchez, H., Waller, J., Ameli, H., & Bazargan, M. (2023). Factors Associated With Telehealth Utilization Among Older African Americans in South Los Angeles During the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 20(3), 2675. https://doi.org/10.3390/ijerph20032675 DOI: https://doi.org/10.3390/ijerph20032675
Eppler, M., Brock, K., Brunkow, C., & Mulcahy, E. R. (2022). Perceptions of Barriers: An Examination of Public Health Practice in Kansas. International Journal of Environmental Research and Public Health, 19(9), 5513. https://doi.org/10.3390/ijerph19095513 DOI: https://doi.org/10.3390/ijerph19095513
Escobar, M. F., Gallego, J. C., Echavarría, M. P., Fernández, P., Posada, L., Salazar, S., Gutierrez, I., & Alarcón, J. (2022). Maternal and Perinatal Outcomes in Mixed Antenatal Care Modality Implementing Telemedicine in the Southwestern Region of Colombia. https://doi.org/10.21203/rs.3.rs-2140031/v1 DOI: https://doi.org/10.21203/rs.3.rs-2140031/v1
Fleary, S. A., Joseph, P. L., & Pappagianopoulos, J. (2017). Adolescent Health Literacy and Health Behaviors: A Systematic Review. Journal of Adolescence, 62(1), 116–127. https://doi.org/10.1016/j.adolescence.2017.11.010 DOI: https://doi.org/10.1016/j.adolescence.2017.11.010
Ghanbari, S., Ramezankhani, A., Montazeri, A., & Mehrabi, Y. (2016). Health Literacy Measure for Adolescents (HELMA): Development and Psychometric Properties. Plos One, 11(2), e0149202. https://doi.org/10.1371/journal.pone.0149202 DOI: https://doi.org/10.1371/journal.pone.0149202
Gutiérrez, C. S., Gil‐García, E., Rivera, A., & López‐Millán, J. M. (2022). Effectiveness of Telemedicine Psychoeducational Interventions for Adults With Non‐oncological Chronic Disease: A Systematic Review. Journal of Advanced Nursing, 78(5), 1267–1280. https://doi.org/10.1111/jan.15151 DOI: https://doi.org/10.1111/jan.15151
Hawkes, C., Norris, K., Joyce, J., & Paton, D. (2021). A Qualitative Investigation of Mental Health in Women of Refugee Background Resettled in Tasmania, Australia. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-11934-y DOI: https://doi.org/10.1186/s12889-021-11934-y
Hyde-Quartey, L., Zhang, X., & Ahoto, A. T. (2023). Drivers and Barriers to the Adoption of Telemedicine Among Persons With Chronic Health Conditions in Ghana. Int L Journal of Management Innovation Systems, 8(1), 29. https://doi.org/10.5296/ijmis.v8i1.20370 DOI: https://doi.org/10.5296/ijmis.v8i1.20370
Jenkins, E., Bungay, V., Patterson, A. C., Saewyc, E., & Johnson, J. L. (2018). Assessing the Impacts and Outcomes of Youth Driven Mental Health Promotion: A Mixed‐methods Assessment of the Social Networking Action for Resilience Study. Journal of Adolescence, 67(1), 1–11. https://doi.org/10.1016/j.adolescence.2018.05.009 DOI: https://doi.org/10.1016/j.adolescence.2018.05.009
Kelly, W., McGrath, B., & Hubbard, D. (2022). Starting From ‘Scratch’: Building Young People’s Digital Skills Through a Coding Club Collaboration With Rural Public Libraries. Journal of Librarianship and Information Science, 55(2), 487–499. https://doi.org/10.1177/09610006221090953 DOI: https://doi.org/10.1177/09610006221090953
Khan, S., Bond, S., Bakhit, M., Hasan, S. S., Sadeq, A., Conway, B. R., & Aldeyab, M. A. (2022). COVID-19 Mixed Impact on Hospital Antimicrobial Stewardship Activities: A Qualitative Study in UK-Based Hospitals. Antibiotics, 11(11), 1600. https://doi.org/10.3390/antibiotics11111600 DOI: https://doi.org/10.3390/antibiotics11111600
Kim, H., Sefcik, J. S., & Bradway, C. (2016). Characteristics of Qualitative Descriptive Studies: A Systematic Review. Research in Nursing & Health, 40(1), 23–42. https://doi.org/10.1002/nur.21768 DOI: https://doi.org/10.1002/nur.21768
Latulippe, K., Hamel, C., & Giroux, D. (2017). Social Health Inequalities and eHealth: A Literature Review With Qualitative Synthesis of Theoretical and Empirical Studies. Journal of Medical Internet Research, 19(4), e136. https://doi.org/10.2196/jmir.6731 DOI: https://doi.org/10.2196/jmir.6731
Liu, T., Hsiao, R. C., Chou, W., & Yen, C. (2021). Perpetration of and Victimization in Cyberbullying and Traditional Bullying in Adolescents With Attention-Deficit/Hyperactivity Disorder: Roles of Impulsivity, Frustration Intolerance, and Hostility. International Journal of Environmental Research and Public Health, 18(13), 6872. https://doi.org/10.3390/ijerph18136872 DOI: https://doi.org/10.3390/ijerph18136872
Loder, A., & Axhausen, K. W. (2018). Mobility Tools and Use: Accessibility’s Role in Switzerland. Journal of Transport and Land Use, 11(1). https://doi.org/10.5198/jtlu.2018.1054 DOI: https://doi.org/10.5198/jtlu.2018.1054
Manganello, J. A., DeVellis, R. F., Davis, T. C., & Schottler-Thal, C. E. (2015). Development of the Health Literacy Assessment Scale for Adolescents (HAS-A). Journal of Communications in Healthcare, 8(3), 172–184. https://doi.org/10.1179/1753807615y.0000000016 DOI: https://doi.org/10.1179/1753807615Y.0000000016
Mehmet, M., Roberts, R., & Nayeem, T. (2020). Using Digital and Social Media for Health Promotion: A Social Marketing Approach for Addressing Co‐morbid Physical and Mental Health. Australian Journal of Rural Health, 28(2), 149–158. https://doi.org/10.1111/ajr.12589 DOI: https://doi.org/10.1111/ajr.12589
Mehrolhassani, M. H., Yazdi‐Feyzabadi, V., Dehnavieh, R., Bahaadinbeigy, K., & kargar, mohammad. (2022). Barriers to Telemedicine Establishment and Development in Iran: A Systematic Review. https://doi.org/10.21203/rs.3.rs-2307446/v1 DOI: https://doi.org/10.21203/rs.3.rs-2307446/v1
Mooghali, M., Stroud, A. M., Yoo, D. W., Barry, B., Grimshaw, A., Ross, J. S., Zhu, X., & Miller, J. (2023). Barriers and Facilitators to Trustworthy and Ethical AI-enabled Medical Care From Patient’s and Healthcare Provider’s Perspectives: A Literature Review. https://doi.org/10.1101/2023.10.02.23296447 DOI: https://doi.org/10.1101/2023.10.02.23296447
Noceda, A. V. G., Acierto, L. M. M., Bertiz, M. C. C., Dionisio, D. E. H., Laurito, C. B. L., Sanchez, G. A. T., & Loreche, A. M. (2023). Patient Satisfaction With Telemedicine in the Philippines During the COVID-19 Pandemic: A Mixed Methods Study. BMC Health Services Research, 23(1). https://doi.org/10.1186/s12913-023-09127-x DOI: https://doi.org/10.1186/s12913-023-09127-x
Okano, J. T., Ponce, J., Krönke, M., & Blower, S. (2022). Lack of Ownership of Mobile Phones Could Hinder the Rollout of mHealth Interventions in Africa. Elife, 11. https://doi.org/10.7554/elife.79615 DOI: https://doi.org/10.7554/eLife.79615
Omboni, S., Padwal, R., Alessa, T., Benczúr, B., Green, B. B., Hubbard, I., Kario, K., Khan, N., Конради, А. О., Logan, A. G., Lü, Y., Mars, M., McManus, R. J., Melville, S., Neumann, C., Parati, G., Renna, N. F., Ryvlin, P., Saner, H., … Wang, J. (2022). The Worldwide Impact of Telemedicine During COVID-19: Current Evidence and Recommendations for the Future. Ch. https://doi.org/10.20517/ch.2021.03 DOI: https://doi.org/10.20517/ch.2021.03
Parkes, P., Pillay, T. D., Bdaiwi, Y., Simpson, R., Almoshmosh, N., Murad, L., & Abbara, A. (2022). Telemedicine Interventions in Six Conflict-Affected Countries in the WHO Eastern Mediterranean Region: A Systematic Review. Conflict and Health, 16(1). https://doi.org/10.1186/s13031-022-00493-7 DOI: https://doi.org/10.1186/s13031-022-00493-7
Paterno, M. T., Leckenby, D., & Pachucki, M. C. (2020). Challenges and Lessons Learned From Digital Storytelling With Parenting Women in Recovery. Health Promotion Practice, 21(3), 340–343. https://doi.org/10.1177/1524839920902751 DOI: https://doi.org/10.1177/1524839920902751
Price, L., Deville, J., & Ashmore, F. (2021). A Guide to Developing a Rural Digital Hub. Local Economy the Journal of the Local Economy Policy Unit, 36(7–8), 683–694. https://doi.org/10.1177/02690942221077575 DOI: https://doi.org/10.1177/02690942221077575
Rasekaba, T., Pereira, P., G, V. R., Johnson, R., McKechnie, R., & Blackberry, I. (2022). Exploring Telehealth Readiness in a Resource Limited Setting: Digital and Health Literacy Among Older People in Rural India (DAHLIA). Geriatrics, 7(2), 28. https://doi.org/10.3390/geriatrics7020028 DOI: https://doi.org/10.3390/geriatrics7020028
Saigí-Rubió, F. (2023). Promoting Telemedicine in Latin America in Light of COVID-19. Revista Panamericana De Salud Pública, 47, 1. https://doi.org/10.26633/rpsp.2023.17 DOI: https://doi.org/10.26633/RPSP.2023.17
Shao, C., McLeod, C., Gleason, L., Marques, I., Chu, D. I., Wallace, E., Fouad, M. N., & Reddy, S. (2022). Inequity in Telemedicine Use Among Patients With Cancer in the Deep South During the COVID-19 Pandemic. The Oncologist, 27(7), 555–564. https://doi.org/10.1093/oncolo/oyac046 DOI: https://doi.org/10.1093/oncolo/oyac046
Silfee, V., Williams, K., Leber, B. D., Kogan, J. N., Nikolajski, C., Szigethy, E., & Serio, C. D. (2021). Health Care Provider Perspectives on the Use of a Digital Behavioral Health App to Support Patients: Qualitative Study. Jmir Formative Research, 5(9), e28538. https://doi.org/10.2196/28538 DOI: https://doi.org/10.2196/28538
Sinha, E. (2022). Identifying Enablers and Outcomes of Circular Economy for Sustainable Development: A Systematic Literature Review. Business Strategy & Development, 5(3), 232–244. https://doi.org/10.1002/bsd2.195 DOI: https://doi.org/10.1002/bsd2.195
Stanyon, M., Streater, A., Coleston-Shields, D. M., Yates, J., Challis, D., Dening, T., Hoe, J., Lloyd‐Evans, B., Mitchell, S., Moniz‐Cook, E., Poland, F., Prothero, D., & Orrell, M. (2021). Development of an Evidence-Based Best Practice Model for Teams Managing Crisis in Dementia: Protocol for a Qualitative Study. Jmir Research Protocols, 10(1), e14781. https://doi.org/10.2196/14781 DOI: https://doi.org/10.2196/14781
Trevillion, K., Stuart, R., Ocloo, J., Broeckelmann, E., Jeffreys, S., Jeynes, T., Allen, D., Russell, J., Billings, J., Crawford, M., Dale, O., Haigh, R., Moran, P., McNicholas, S., Nicholls, V., Foye, U., Simpson, A., Lloyd‐Evans, B., Johnson, S., & Oram, S. (2021). Service User Perspectives of Community Mental Health Services for People With Complex Emotional Needs: A Co-Produced Qualitative Interview Study. https://doi.org/10.1101/2021.06.24.21259476 DOI: https://doi.org/10.1101/2021.06.24.21259476
Walters, J., Johnson, T. M., DeBlasio, D., Klein, M., Sikora, K., Reilly, K., Hutzel‐Dunham, E., White, C., Xu, Y., & Burkhardt, M. C. (2021). Integration and Impact of Telemedicine in Underserved Pediatric Primary Care. Clinical Pediatrics, 60(11–12), 452–458. https://doi.org/10.1177/00099228211039621 DOI: https://doi.org/10.1177/00099228211039621
Whitehead, L., Robinson, S., Arabiat, D., Jenkins, M. A., & Mörelius, E. (2022). The Report of Access and Engagement With Digital Health Interventions Among Children and Young People: Systematic Review (Preprint). https://doi.org/10.2196/preprints.44199 DOI: https://doi.org/10.2196/preprints.44199
Yin, Z., Errisuriz, V. L., Evans, M., Inupakutika, D., Kaghyan, S., Li, S., Esparza, L., Akopian, D., & Parra‐Medina, D. (2020). A Digital Health Intervention for Weight Management for Latino Families Living in Rural Communities: Perspectives and Lessons Learned During Development (Preprint). https://doi.org/10.2196/preprints.20679 DOI: https://doi.org/10.2196/preprints.20679
Yousef, M., Li, M., Sengar, A., & Lim, C. H. (2023). Safe and Reliable Inpatient Chemotherapy Administration: Impact of an Ambulatory Oncology Pharmacist. Jco Oncology Practice, 19(11_suppl), 389–389. https://doi.org/10.1200/op.2023.19.11_suppl.389 DOI: https://doi.org/10.1200/OP.2023.19.11_suppl.389
