Background: The digital health divide for socioeconomic disadvantage describes a pattern in which patients considered socioeconomically disadvantaged, who are already marginalized through reduced access to face-to-face health care, are additionally hindered through less access to patient-initiated digital health. A comprehensive understanding of how patients with socioeconomic disadvantage access and experience digital health is essential for improving the digital health divide. Primary care patients, especially those with chronic disease, have experience of the stages of initial help seeking and self-management of their health, which renders them a key demographic for research on patient-initiated digital health access. Objective: This study aims to provide comprehensive primary mixed methods data on the patient experience of barriers to digital health access, with a focus on the digital health divide. Methods: We applied an exploratory mixed methods design to ensure that our survey was primarily shaped by the experiences of our interviewees. First, we qualitatively explored the experience of digital health for 19 patients with socioeconomic disadvantage and chronic disease and second, we quantitatively measured some of these findings by designing and administering a survey to 487 Australian general practice patients from 24 general practices. Results: In our qualitative first phase, the key barriers found to accessing digital health included (1) strong patient preference for human-based health services; (2) low trust in digital health services; (3) high financial costs of necessary tools, maintenance, and repairs; (4) poor publicly available internet access options; (5) reduced capacity to engage due to increased life pressures; and (6) low self-efficacy and confidence in using digital health. In our quantitative second phase, 31% (151/487) of the survey participants were found to have never used a form of digital health, while 10.7% (52/487) were low- to medium-frequency users and 48.5% (236/487) were high-frequency users. High-frequency users were more likely to be interested in digital health and had higher self-efficacy. Low-frequency users were more likely to report difficulty affording the financial costs needed for digital access. Conclusions: While general digital interest, financial cost, and digital health literacy and empowerment are clear factors in digital health access in a broad primary care population, the digital health divide is also facilitated in part by a stepped series of complex and cumulative barriers. Genuinely improving digital health access for 1 cohort or even 1 person requires a series of multiple different interventions tailored to specific sequential barriers. Within primary care, patient-centered care that continues to recognize the complex individual needs of, and barriers facing, each patient should be part of addressing the digital health divide.

中文翻译：

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评估初级保健患者的数字健康体验：混合方法研究

背景：社会经济弱势群体的数字健康鸿沟描述了一种模式，即被认为处于社会经济弱势地位的患者，他们已经因获得面对面医疗保健的机会减少而被边缘化，并且由于获得患者发起的数字医疗的机会减少而受到额外的阻碍。全面了解社会经济弱势患者如何获得和体验数字健康对于改善数字健康鸿沟至关重要。初级保健患者，尤其是慢性病患者，经历过最初寻求帮助和自我管理健康的阶段，这使他们成为患者发起的数字健康访问研究的关键人群。目的：本研究旨在提供有关数字医疗获取障碍的患者体验的全面的主要混合方法数据，重点关注数字健康鸿沟。方法：我们采用了探索性混合方法设计，以确保我们的调查主要由受访者的经历决定。首先，我们定性地探索了 19 名患有社会经济劣势和患有慢性疾病的患者的数字健康体验；其次，我们通过设计和实施一项针对来自 24 个全科诊所的 487 名澳大利亚全科患者的调查，定量测量了其中的一些发现。结果：在我们的定性第一阶段，发现获得数字医疗的主要障碍包括（1）患者对以人为本的医疗服务的强烈偏好； (2) 对数字医疗服务信任度低； (3) 必要的工具、维护和修理的高昂财务成本； (4) 公共互联网接入选项较差； (5)由于生活压力增加而降低参与能力； (6) 使用数字健康的自我效能感和信心较低。在我们的定量第二阶段中，发现 31% (151/487) 的调查参与者从未使用过某种形式的数字健康，而 10.7% (52/487) 是中低频用户，48.5% (236 /487）是高频用户。高频用户对数字健康更感兴趣，自我效能感更高。低频用户更有可能报告难以承担数字访问所需的财务成本。结论：虽然普遍的数字兴趣、财务成本以及数字健康素养和赋权是广大初级保健人群获得数字健康的明显因素，但一系列复杂且累积的障碍也在一定程度上加剧了数字健康鸿沟。要真正改善一个群体甚至一个人的数字健康可及性，需要针对特定​​的连续障碍采取一系列多种不同的干预措施。在初级保健中，以患者为中心的护理继续认识到每个患者复杂的个人需求和面临的障碍，应该成为解决数字健康鸿沟的一部分。