Date of Completion

Spring 5-10-2022

Document Type

Campus Access Project

Degree Name

Doctor of Nursing Practice (DNP)

Faculty Advisor

Eileen M Stuart-Shor, PhD, ANP-BC, FAHA, FAAN

Site Advisor

Charlotte Piper, MsC

Abstract

Background: Digital health, which includes telehealth, telemedicine, mobile health apps and wearable technologies, has been viewed by many as an accelerator toward attainment of universal access to health. Tools facilitated by digital health, like the use of telemedicine to improve diabetes management, are successful at achieving outcomes that outpace conventional care. However, not all patients have equal access or ability to use digital health. Factors such as age, gender, race, geographic location, economic status, and primary language can impact whether a person will be able to use a digital health program.

Available Knowledge: There is limited available research evaluating strategies to mitigate the problem, however expert consensus from multiple groups focuses on common strategies to increase health equity in digital health. These include solving for equipment access, improving broadband access, addressing technology literacy issues, creating multilingual access, and acknowledging and fixing technology design issues.

Aims: The purpose of this project is to increase the representation of diverse populations in digital health programming at a large integrated health system. The overarching aim is to integrate a health equity impact assessment into the design of a pilot digital health program to prove feasibility and to propose a similar process in future projects created by the department. The setting for this project is the innovation department at a large integrated health system in New Orleans, Louisiana.

Intervention: The Health Equity Impact Assessment (HEIA) toolkit was used during focus group conversations with team members to identify unintended positive impacts, unintended negative impacts, and mitigation strategies for a new digital health program developed by the innovation department. Following the focus groups, the team members were surveyed to assess feasibility of using the HEIA toolkit for future programs.

Conclusions: This quality improvement project successfully piloted the use of the HEIA toolkit during program design for a fall prevention digital health program. The discussions facilitated by the HEIA toolkit led to adoption of mitigation strategies in the pilot program; these strategies, including an improved orientation to technology, are easily translatable to all other programs developed by the department. The project showed that team members involved in digital health program design are interested in discussing unintended positive and negative impact of digital health programs, as well as mitigation strategies to address those negative impacts. The positive post-focus group surveys suggest that there is an opportunity to scale up the incorporation of the HEIA toolkit into digital program design in future projects. In the future, the HEIA toolkit should be used in the pre-implementation phase, to anticipate as many mitigation strategies as possible prior to program launch.

Comments

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