Fostering Greater Use of
Digital Health Technology 
for Healthier Moms and Families

As with many systems of service and communication in our modern society, health care is increasingly becoming reliant on digital technology to enhance its efficiency and ability to deliver more personalized, data-driven care. From electronic medical record systems that capture and relay important health information to online interactions between patients and providers, it’s becoming clear that the future of health care is digital.

But what happens when some people are not able to participate in the digital economy, whether by their limited access to the tools of technology, their lack of readiness to engage in digital spaces, or by a multitude of priorities in daily life that compete for their time and attention? When such a “digital divide” arises in health care, the consequences can dramatically impact the health and well-being of those populations.

recent study by the Pew Research Center notes that, historically, concerns about the digital divide have tended to focus on people's ability to access digital technology. But access is only one facet of the digital divide. For public health advocates, researchers, and those working to support the health needs of underserved populations, the question of digital readiness must be explored. Only when we understand the extent to which people trust technology and make effective use of digital platforms to gather and assess information can we better support engagement with these tools to help them manage their health. 

For many years concerns about 'digital divides' centered primarily on whether people had access to digital technologies. Now, those worried about these issues also focus on the degree to which people succeed or struggle when they use technology to try to navigate their environments, solve problems, and make decisions.

~ Digital Readiness Gaps, Pew Research Center, September 2016

Strengthening digital readiness and the ability to use digital health solutions is a critical step in increasing patient engagement and reinforcing their connection with health care providers. Recognizing that patients who are engaged in their health care and treatment often experience better health outcomes, the Helen Wallace Center for Maternal and Child Health at the University of California Berkeley’s School of Public Health, in partnership with the Public Health Institute, published a study in the Journal of International Medical Research exploring the influences on patient engagement in the digital space. Specifically, researchers wanted to better understand the dynamics that affect the adoption and use of digital health tools and better grasp the psychological motivators that lead to greater digital readiness and engagement. They focused their study on first-time pregnant women and mothers caring for children under the age of five, as evidence shows that these populations have a strong desire to acquire health information and seek social support through digital health tools.

Researchers from the Wallace Center and Public Health Institute conducted community listening sessions at three sites across the U.S. — San Francisco Bay Area, New York's South Bronx district, and West Louisville in Kentucky — that focused on how participants experience and use technology for managing their health and/or their children’s health. By investigating how these women interact with tools such as websites, apps, wearables, social networks, video chats, and patient portals, researchers hoped to uncover insights that could be used to support both consumers and providers in electronic patient engagement and inform the future design, adoption, and utilization of digital health technology.

Use the drop down menu below to explore the characteristics of the study participants.

Evidence indicates that first-time pregnant women or those caring for their first infant are particularly likely to use digital health technology since they have a stronger need and desire to acquire pregnancy and child health information and seek social support.

~ Listening to Communities: 
A mixed method study of disadvantaged mothers
and pregnant women’s engagement with
digital health technologies, 
Wallace Center, Journal of Medical Internet Research

A Deeper Look: Digital Health Use Among 
Low-Income Pregnant Women and New Mothers

To inform their investigation, researchers asked participants to provide information on three behaviors related to their use of digital health technology: the number and subject of online health information seeking activities they conducted in the preceding 12 months, the extent of their current use of technology to manage their own or their child’s health, and their interest in using such technology in the future.

Participants were also asked to rate themselves on their level of eHealth literacy (an estimate of their knowledge, confidence, and skill at finding, evaluating, and applying electronic health information to health problems), their internal motivation to engage in healthy attitudes and behaviors, and their overall trust in digital health information.

Most of the women who participated in the study had high access to technology – 84% owned or had access to a computer and 87% owned or used a smartphone — and their access was strongly correlated with a tendency to engage in online searches for health information, albeit with varying degrees of confidence and precision. But many of the participants still did not utilize digital tools, beyond internet searches, to manage their own or their children’s health. Approximately 42% of the study participants reported no use of digital health technology and 30% of participants reported low use. Only 27% of participants were high users of digital health management tools.

Despite the widespread roll-out of patient portals, participants in the study often lacked awareness of their existence and knowledge of the key features and benefits of their use. Participants often expressed a preference for face-to-face interactions with care providers and other mothers or a general desire to protect their online privacy and personal space.

The study also revealed that, among the women reporting no or low use of digital tools to manage their own or their children’s health, 49% expressed a strong interest in engaging with those tools in the future. Such promising attitudes indicate that, with the right support for learning and using digital health tools, these women could develop a greater level of engagement with health technology that could ultimately translate into stronger connections with their providers and better health outcomes for them and their families.

Beyond Access: Motivational Drivers for Use of Digital Health Technology

As researchers examined the data they gathered from their study, several trends emerged indicating that the source for strengthening patient engagement with digital health technology may lie in tapping associated motivations and behaviors.

I went to Google, typed in my question, and got all of these different answers. I picked one that gave me better answers. I registered with them so that I would get emails from that website.

~ Focus group participant

•    Researchers noted that women who sought out health information on the internet with greater frequency were more likely to rate themselves as having higher health literacy, indicating that these competencies are foundational for engaging in online health searches.

•    Women who showed a strong internal motivation to engage in healthy attitudes and behaviors were more likely to use digital health management tools.

•    Women who held a greater sense of trust in digital information overall were also more likely to express interest in the future adoption of digital health tools.

To date, most research has focused on the importance of health literacy as a driver of use of digital health technology. While it’s too early to draw wide conclusions, future research on digital health drivers could illuminate the extent to which internal health orientations and attitudes of trust are key motivations that support greater engagement with digital health management tools.

It is very important to me to manage privacy settings especially since my kids use [my phone]. I am a private person and make sure I limit what I share to certain people. I trust test results via the portal.

~ Focus group participant

Looking Ahead: A Whole-System Approach to Digital Health Technology

We are in an era of health care in the U.S. where taking responsibility for one’s own health and engaging with the digital health management tools that make access to and utilization of care and treatment services more readily accessible are practically a requirement. There is extensive evidence showing that engaged patients who collaborate with their providers in the exchange of health information and treatment decisions often experience better health outcomes.

The Wallace Center-PHI study provides important insights for what is necessary to achieve optimal engagement from consumers in the digital health space. It also highlights what is at risk if we don’t attend to the core motivations and competencies that lead to greater engagement.

Disadvantaged populations — those with limited incomes, who may have limited health literacy, or who experience other barriers to changing health behaviors — will be disproportionately affected by the digitization of health care, ultimately perpetuating greater health disparities. When considering these dynamics among low-income mothers and pregnant women, often the primary health decision-makers for their families, the urgency to address these motivations and competencies becomes even more pronounced.

To avoid exacerbating the digital and health disparities, health care consumers, providers and educators, community organizations, and developers of digital health tools all need to work together so that consumers who are lagging behind in their technology use can be empowered and strengthened in their engagement in the digital space. The Wallace Center study makes a strong case for developing a whole-systems approach to digital health technology that not only requires the development of better tools but also creates a better foundation among all consumers for digital readiness, trust in technology, and stronger personal agency in attending to one’s health needs.

I’m interested in connecting more with my doctor and my kids’ doctor,
but who is there to help me do it?

~ Focus group participant

The following action strategies may serve to highlight useful tactics for those working in the health care and digital technology spaces in order to achieve this whole-systems approach. They underscore the importance of gathering insights from providers and working with consumers to co-design digital health solutions, promoting awareness of these technologies as a means for actively managing one’s health, developing trainings that can strengthen user skills and confidence in searching for and using online health information resources, and conducting further research to understand the motivations and barriers to digital health utilization.

A Call to Action for Health Care Providers, Health Educators, and Health Plans

•    Encourage the use of digital health tools that are available

•    Talk to patients about their use of patient portals and apps

•    Enable trainings that highlight and support the use of digital health tools

•    Prioritize the usability of health care portals and apps, addressing security and language barriers

The Wallace Center-PHI study shows that online health-seeking activity may be an important indicator of and gateway towards a woman’s active participation in her health and the health of her child. So it’s important that health care providers encourage and support these consumers in using the variety of digital health tools at their dispense, especially the internet. Providers should talk to their patients about their internet search behaviors and make sure they are aware of patient portals and how to use them. They should get to know consumers' comfort and experience with using digital health portals and apps to identify interests, as well as skill gaps, that could affect the adoption of digital technologies. And it's important to address their concerns about privacy protection and the trustworthiness of information.

Health educators, particularly those working in maternal and child health, need to take an active role in enabling trainings that increase public awareness and build greater personal agency in the use of different digital health tools. Explain how these tools work and identify the potential benefits, as well as the risks, to safety, security, and privacy. Frame these tools as complementary, not in opposition to, the face-to-face and personal interactions that many of these consumers seek.

Health plans play a particularly important role in fostering the skills, confidence, and trust in the use of the very tools they have employed in their health care operations and interactions. Their efforts to prioritize the usability of their health care portals and apps, while addressing security concerns and language barriers, can go a long way.

A Call to Action for Potential Partners & Funders

•    Foster further research to explore the motivations and barriers to digital health use

•    Involve both the consumer and provider in future research on this topic

The research that the Wallace Center has done to date on this topic has yielded a plethora of helpful insights. But there is more research that needs to be done. The Wallace Center welcomes the opportunity to partner with other organizations, educational institutions, researchers, and funders to further explore the motivations and barriers that consumers experience in their use of digital health technologies. Only by engaging in a whole-system approach that involves both the consumer and the provider of health technology can we begin to translate the findings of this research to transform health and health care and reduce inequities.

A Call to Action for Developers of Digital Health Tools

•    Involve consumers and providers in the design process

•    Become familiar with existing research to inform designs of digital health tools

It almost goes without saying that those who create digital health tools need to make a greater effort to place the consumer and providers at the center of their design efforts. They need to bring consumers into their ideation and design processes early on so that the tools they design can be created in a way that makes them both desirable and accessible to consumers. Furthermore, they need to be informed about research that is out there around digital health technology use and accessibility, to understand the barriers and motivations that consumers have, and use those studies to inform their designs and design process. Only in doing so will they be successful at designing tools and interventions that truly address the interests of consumers and enhance consumer competencies to manage their own and their family’s health.

A Call to Action for All

•    Identify and advocate for opportunities to better design tools and trainings

•    Become engaged in the conversation

Health disparities, like all disparities in society, require everyone to be engaged if we are to be successful in eliminating them. Each of us will increasingly come face to face with digital health technology in our daily lives. Therefore, we each have the opportunity to be advocates for digital readiness, both our own and that of others. It is important that we speak up when we identify opportunities for improvement in the design and enablement of digital health tools. And we need to grow our voice in calling for better training in using and understanding these tools.

If you would like to join in on the conversation and help advocate for these issues, contact Sylvia Guendelman at the UC Berkeley Wallace Center for Maternal and Child Health.

Acknowledgements

The Helen Wallace Center for Maternal and Child Health at the University of California's Berkeley School of Public Health was founded in spring 2015 at the bequest of Dr. Helen Wallace, a world-renowned professor, mentor, and advocate for improving the lives of women and children. The Wallace Center's mission is to advance maternal, child, and adolescent health, and to reduce health disparities, with a focus on technology, innovation, and community engagement.

The content of this story was informed by a study conducted by faculty and students at the Wallace Center in collaboration with the Public Health Institute. The study — "Listening to Communities: A mixed method study of disadvantaged mothers and pregnant women’s engagement with digital health technologies" — was published in the Journal of International Medical Research and co-authored by Sylvia Guendelman, Andrew Broderick, Hmellisa Mlo, Alison Gemmill and David Lindeman.

We would like to express our heartfelt thanks to all the clinic providers and mothers who generously gave their time and shared their attitudes, opinions, and behaviors about the use of health technology. This study would not have been possible without support from:

The Public Health Institute, dedicated to improving health and wellness through research, partnerships, and programs that advance                   health policy improvements.

The Center for Information Technology Research in the Interest of Society (CITRIS) and the Banatao Institute, working to create                                     technology solutions for society’s most pressing challenges.

Aetna Foundation, a national foundation based in Hartford, Connecticut that supports projects to promote wellness, health and access                   to high-quality health care for everyone. The views presented here are those of the author and not necessarily those of the Aetna                                 Foundation, its directors, officers, or staff.