Technology as a Social Determinant of Health
When a COVID Test Gets in its Own Way
One of our Reemates recently shared a story about their child contracting COVID-19 at daycare. They were kindly sent home with a box of free tests. Come back after five days and a negative test, they were told. When the child was symptom free, the parent retrieved the box of tests but was dismayed to see that they would need an app to evaluate the results. Requiring a smartphone and an app seemed unnecessary and a hassle. They described how they would likely need to find the app, download it, create an account, log in, and then figure out how to use it. With breakfast to make and a child to wrangle, they put the box back and got another test that didn’t require an app. The Reemate didn’t actually know if the app was required. Perhaps they could have seen a positive or negative result without it, but they never opened the box to find out. The very idea of needing the app was a barrier.
Embedding COVID tests within a digital experience exemplifies how technology becomes a social determinant of health. If this Reemate—a tech savvy individual comfortable installing and using apps regularly—was reluctant to use these tests, what of the person who isn’t as comfortable or doesn’t have a cell phone or pays for data on their plan or doesn’t have an email address to sign up? For them, their access to technology or their digital literacy limits their ability to manage their health.
The Digital Literacy Spectrum
This problem exists on a continuum and isn’t just limited to using healthcare apps—it’s about using email, a portal, or even wearable fitness trackers. A recent study from the NIH’s All of Us Research Program found that while the majority of individuals surveyed showed an interest in a wearable fitness tracker, a variety of barriers prevented their widespread adoption, including cost, information, and privacy. A fitness tracker, particularly one that shares health data with an insurance company, can be used to monitor and anticipate health issues. The user is prodded to exercise and the health insurance company acquires data allowing them to intervene before costly care is needed. But wearables are on the far end of the technology spectrum, and so it’s no surprise that the barriers to adoption are greatest for those traditionally underserved by the healthcare industry. If a COVID test that requires a smartphone isn’t accessible, then neither is a wearable which also requires a smartphone.
At Reema, we aren’t interested in this side of the spectrum. When we read this study, what stands out isn’t the lack of wearables—the populations we serve have little interest in wearables as fitness devices. What stands out is the fact that many of the participants struggled to complete the survey in the first place, which used email and a QR code to access a Survey Monkey questionnaire. This fact points to more fundamental digital literacies than those needed to adopt and use a wearable. We’re interested in this side of the spectrum: setting up email, configuring cell phones, signing into accounts, connecting to wifi, filling out forms, navigating portals, etc.
Would a wearable encourage Reema’s members to be healthier? Perhaps. Would users struggle to enroll, share data, wear often, and charge regularly? Definitely. Would these devices be sold to buy groceries or pay for health care? Sometimes. Would wearables allow their actions and lifestyle to be more easily surveilled. Absolutely. Are there more important things our members need than a wearable? There are.
A Nuanced Approach to Technology as a SDoH
Fundamentally, our personalized approach has allowed us to understand the needs of Medicaid and Medicare members. Seeing these trends has reinforced our decision not to develop an app for users. Too many of our members simply have too much to do because they are navigating other challenges, like housing, transportation, or employment. And even if they did have time, regularly using an app would be a further barrier to entry.
So we use a technology more broadly available to 90% of our members: text messaging. And because we see not only broad trends but the needs of individual members, if someone doesn’t have access to text messaging, our Guides connect members with phone calls and in-person visits. Our granular understanding of member needs means that no one’s access to technology ever impedes real engagement.
As part of that engagement we help individuals more fully participate in digital society by working with them to create emails, reset passwords, manage spam, set up phones and computers, connect to wifi, and navigate assistive technologies and classes for limited blindness and deafness. This significantly improves their digital literacy and opens new ways for them to be in the world with others.
While we like to think of technology as all the newest gadgets, it’s also important to remember that for many the more mundane technologies we often take for granted are not available: food, housing, and transportation.
While we like to think of technology as all the newest gadgets, it’s also important to remember that for many the more mundane technologies we often take for granted are not available: food, housing, and transportation. These aren’t “digital” technologies, but they are often required before more advanced technologies are adopted.
This is where Reema works because this is where our members are. And we bring to each interaction the shared identities necessary to build the kinds of relationships where these needs can be met.
Wearables? Sure. One day. But today, let’s ensure they have a place where that wearable can be charged and that they feel comfortable accessing and sharing the data it collects.