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eHealth: who are we leaving behind? (and how we can take them along for the ride)

By Chelsea Coumoundouros Published 04.02.2020

eHealth – health programs or information delivered using the internet or other technologies – has the ability to deliver care to, well – everyone. Distance between an individual and their care provider no longer matters. Costs of getting to and from appointments – gone. Worries about being seen in the office of a care provider you aren’t ready to have friends and family know you visit - eliminated. Why? Because one of the great features of eHealth is that you can access it from the comfort and privacy of your own home.

But what if you don’t own a computer or feel comfortable using one? What if you don’t have internet access or can’t afford to pay for large internet data plans? These factors lead to people being digitally excluded – left unable to use the eHealth programs available to others.

How many people are digitally excluded? It’s hard to say exactly, but we do have some information that helps to give us an impression of the size of this issue. Globally, only around54% of the population had access to the internet in 2019, with low-income countries having some of the lowest internet access rates.1 This leaves billions of individuals without access to the internet and eHealth programs which could improve their ability to access healthcare. However, digital exclusion expands beyond not having internet access. For example, although in the UK only 4% of households do not have internet access,2 many individuals experience other challenges that may leave them digitally excluded, such as the high cost of internet data, not having much experience using the internet, or not trusting the security of eHealth and other online programs [3], [4].

Not everyone is equal when it comes to digital exclusion. Older adults, people with low socioeconomic status (e.g. low income, less education), and those with disabilities are some of the groups of people more likely to be unable to access or use eHealth programs [3],[5]. These same groups often have a higher risk for poor health outcomes [6] and low healthcare access [7]. While we should be aiming to reduce the health disparities that exist between people with different socioeconomic backgrounds, eHealth programs often remain inaccessible to those individuals who are most in need of the support these programs offer.

What can we do to make sure eHealth programs are available to the people who could benefit from them the most?

Eliminating digital exclusion would require a complex solution made of different parts to address the many societal (e.g. high cost of internet set by internet providers or poor internet service connection to rural communities) and individual (e.g. low confidence or motivation to use eHealth programs) factors that contribute to it. However, researchers working on developing eHealth solutions can take steps to ensure new eHealth programs are accessible to as many people as possible. Taking steps to actively involve a variety of potential users – especially users with different digital skill levels – in the development of eHealth programs can help make sure programs are easy to use and understand. eHealth programs can also be developed with a blended care approach, combining face-to-face sessions with an online program, to better support users who want or need in-person support.

eHealth is a great thing. It can make it easier for people living in rural settings to access healthcare. It can help people feel more comfortable accessing care if they prefer not to do things face-to-face. During the COVID-19 pandemic, it has helped ensure many people can still access care despite lockdowns and concerns about the spread of the virus. However, as we continue to develop eHealth programs and increase the number of services offered digitally, it is essential we not forget that eHealth programs are not a solution for everyone and we have a responsibility to take any steps we can to ensure as few as possible are excluded from the new and valuable programs we create.

Recommended Readings:
Peaked your interest? More interesting reading here:
[1]. Kelly A. (2020) Digital divide ‘isolates and endangers’ millions of UK’s poorest. The Guardian [Accessed Jan 12, 2021]
[2]. Makri A. (2019) Bridging the digital divide in health care. Lancet Digit Health 1(5):E204-E205.doi:10.1016/S2589-7500(19)30111-6

[1].International Telecommunication Union and United Nations Educational, Scientific and Cultural Organization. (2020) State of Broadband Report: 2020.[Accessed Jan 12, 2021]2.
[2].Office for National Statistics. (2020) Internet Access – Households and Individuals, Great Britain: 2020. [Accessed Jan 12, 2021]
[3].NHS Digital. (2020) What We Mean by Digital Inclusion. [Accessed Jan 12, 2021]
[4].Greer B, Robotham D, Simblett S, Curtis H, Griffiths H & Wykes T. (2019) Digital Exclusion Among Mental Health Service Users: Qualitative Investigation.J Med Internet Res. 21(1):e11696. doi:10.2196/11696
[5].Estacio EV, Whittle R & Protheroe J. (2019) The Digital Divide: Examining Socio-Demographic Factors Associated with Health Literacy, Access and Use of Internet to Seek Health Information. J Health Psychol. 24(12):1668-1675. doi: 10.1177/1359105317695429.
[6].Adler NE & Ostrove JM. (1999) Socioeconomic Status and Health: What We Know and What We Don’t. Ann N Y Acad Sci. 896:3-15. doi:10.1111/j.1749-6632.1999.tb08101.x7.McMaughan DJ, Oloruntoba O & Smith ML. (2020) Socioeconomic Status and Access to Healthcare: Interrelated Drivers for Healthy Aging.Front Public Health. 8:231. doi:10.3389/fpubh.2020.00231

About the author: Hi there! I’m Chelsea, a Ph.D. student at Uppsala University in Sweden studying how internet-based mental health programs for family cancer caregivers can be put into practice. When not doing research, you can find me walking around Uppsala, trying new pastries from Güntherska, or making a puzzle at home! Want to connect? Find me on Twitter (@ChelseaCoum) or send me an email at