The Digital Divide in Brazil and Barriers to Telehealth and Equal Digital Health Care: Analysis of Internet Access Using Publicly Available Data
Background The COVID-19 pandemic has increased the use of digital solutions in medical care, especially for patients in remote areas and those requiring regular medical care. However, internet access is essential for the implementation of digital health care. The digital divide is the unequal distr...
| Main Authors: | , , , , , , |
|---|---|
| Other Authors: | |
| Format: | Article |
| Language: | en_US |
| Published: |
JMIR Publications Inc.
2024
|
| Subjects: | |
| Online Access: | https://hdl.handle.net/1721.1/153504 |
| _version_ | 1826199898920321024 |
|---|---|
| author | Nakayama, Luis Filipe Binotti, William Warr Link Woite, Naira Fernandes, Chrystinne Oliveira Alfonso, Pia Gabrielle Celi, Leo Anthony Regatieri, Caio Vinicius |
| author2 | Harvard--MIT Program in Health Sciences and Technology. Laboratory for Computational Physiology |
| author_facet | Harvard--MIT Program in Health Sciences and Technology. Laboratory for Computational Physiology Nakayama, Luis Filipe Binotti, William Warr Link Woite, Naira Fernandes, Chrystinne Oliveira Alfonso, Pia Gabrielle Celi, Leo Anthony Regatieri, Caio Vinicius |
| author_sort | Nakayama, Luis Filipe |
| collection | MIT |
| description | Background
The COVID-19 pandemic has increased the use of digital solutions in medical care, especially for patients in remote areas and those requiring regular medical care. However, internet access is essential for the implementation of digital health care. The digital divide is the unequal distribution of access to digital technology, and the first level digital divide encompasses structural barriers. Brazil, a country with economic inequality and uneven population distribution, faces challenges in achieving internet access for all.
Objective
This study aims to provide a comprehensive overview of the first-level digital divide in Brazil, estimate the relationship between variables, and identify the challenges and opportunities for digital health care implementation.
Methods
Data were retrieved from the Brazilian Institute of Geography and Statistics National Continuous House survey database, including demographic, health, and internet-related variables. Statistical analysis included 2-tailed t tests, chi-square, and multivariate logistic regression to assess associations between variables.
Results
Our analysis included 279,382 interviews throughout Brazil. The sample included more houses from the northeast (n=99,553) and fewer houses from the central west (n=30,804). A total of 223,386 (80.13%) of the interviewed population used the internet, with urban areas having higher internet access (187,671/212,109, 88.48%) than rural areas (35,715/67,077, 53.24%). Among the internet users, those interviewed who lived in urban houses, were women, were younger, and had higher income had a statistically higher prevalence (P<.001). Cell phones were the most common device used to access the internet (141,874/143,836, 98.63%). Reasons for not using the internet included lack of interest, knowledge, availability, and cost, with regional variations. The prevalence of internet access also varied among races, with 84,747 of 98,968 (85.63%) White respondents having access, compared to 22,234 of 28,272 (78.64%) Black respondents, 113,518 of 148,191 (76.6%) multiracial respondents, and 2887 of 3755 (76.88%) other respondents. In the southeast, central west, and south regions, the numbers of people with internet access were 49,790 of 56,298 (88.44%), 27,209 of 30,782 (88.39%), and 27,035 of 31,226 (86.58%), respectively, and in the north and northeast, 45,038 of 61,404 (73.35%) and 74,314 of 99,476 (74.7%). The income of internet users was twice the income of internet nonusers. Among those with diabetes-related limitations in daily activities, 945 of 2377 (39.75%) did not have internet access, and among those with daily activity restrictions, 1381 of 3644 (37.89%) did not have access. In a multivariate logistic regression analysis, women (odds ratio [OR] 1.147, 95% CI 0.118-0.156; P<.001), urban households (OR 6.743, 95% CI 1.888-1.929; P<.001), and those earning more than the minimum wage (OR 2.087, 95% CI 0.716-0.756; P<.01) had a positive association with internet access.
Conclusions
Brazil’s diverse regions have different demographic distributions, house characteristics, and internet access levels, requiring targeted measures to address the first-level digital divide in rural areas and reduce inequalities in digital health solutions. Older people, poor, and rural populations face the greatest challenges in the first level digital divide in Brazil, highlighting the need to tackle the digital divide in order to promote equitable access to digital health care. |
| first_indexed | 2024-09-23T11:27:52Z |
| format | Article |
| id | mit-1721.1/153504 |
| institution | Massachusetts Institute of Technology |
| language | en_US |
| last_indexed | 2024-09-23T11:27:52Z |
| publishDate | 2024 |
| publisher | JMIR Publications Inc. |
| record_format | dspace |
| spelling | mit-1721.1/1535042024-09-20T18:24:43Z The Digital Divide in Brazil and Barriers to Telehealth and Equal Digital Health Care: Analysis of Internet Access Using Publicly Available Data Nakayama, Luis Filipe Binotti, William Warr Link Woite, Naira Fernandes, Chrystinne Oliveira Alfonso, Pia Gabrielle Celi, Leo Anthony Regatieri, Caio Vinicius Harvard--MIT Program in Health Sciences and Technology. Laboratory for Computational Physiology Massachusetts Institute of Technology. Institute for Medical Engineering & Science Health Informatics Background The COVID-19 pandemic has increased the use of digital solutions in medical care, especially for patients in remote areas and those requiring regular medical care. However, internet access is essential for the implementation of digital health care. The digital divide is the unequal distribution of access to digital technology, and the first level digital divide encompasses structural barriers. Brazil, a country with economic inequality and uneven population distribution, faces challenges in achieving internet access for all. Objective This study aims to provide a comprehensive overview of the first-level digital divide in Brazil, estimate the relationship between variables, and identify the challenges and opportunities for digital health care implementation. Methods Data were retrieved from the Brazilian Institute of Geography and Statistics National Continuous House survey database, including demographic, health, and internet-related variables. Statistical analysis included 2-tailed t tests, chi-square, and multivariate logistic regression to assess associations between variables. Results Our analysis included 279,382 interviews throughout Brazil. The sample included more houses from the northeast (n=99,553) and fewer houses from the central west (n=30,804). A total of 223,386 (80.13%) of the interviewed population used the internet, with urban areas having higher internet access (187,671/212,109, 88.48%) than rural areas (35,715/67,077, 53.24%). Among the internet users, those interviewed who lived in urban houses, were women, were younger, and had higher income had a statistically higher prevalence (P<.001). Cell phones were the most common device used to access the internet (141,874/143,836, 98.63%). Reasons for not using the internet included lack of interest, knowledge, availability, and cost, with regional variations. The prevalence of internet access also varied among races, with 84,747 of 98,968 (85.63%) White respondents having access, compared to 22,234 of 28,272 (78.64%) Black respondents, 113,518 of 148,191 (76.6%) multiracial respondents, and 2887 of 3755 (76.88%) other respondents. In the southeast, central west, and south regions, the numbers of people with internet access were 49,790 of 56,298 (88.44%), 27,209 of 30,782 (88.39%), and 27,035 of 31,226 (86.58%), respectively, and in the north and northeast, 45,038 of 61,404 (73.35%) and 74,314 of 99,476 (74.7%). The income of internet users was twice the income of internet nonusers. Among those with diabetes-related limitations in daily activities, 945 of 2377 (39.75%) did not have internet access, and among those with daily activity restrictions, 1381 of 3644 (37.89%) did not have access. In a multivariate logistic regression analysis, women (odds ratio [OR] 1.147, 95% CI 0.118-0.156; P<.001), urban households (OR 6.743, 95% CI 1.888-1.929; P<.001), and those earning more than the minimum wage (OR 2.087, 95% CI 0.716-0.756; P<.01) had a positive association with internet access. Conclusions Brazil’s diverse regions have different demographic distributions, house characteristics, and internet access levels, requiring targeted measures to address the first-level digital divide in rural areas and reduce inequalities in digital health solutions. Older people, poor, and rural populations face the greatest challenges in the first level digital divide in Brazil, highlighting the need to tackle the digital divide in order to promote equitable access to digital health care. 2024-02-12T20:13:17Z 2024-02-12T20:13:17Z 2023-07-21 Article http://purl.org/eprint/type/JournalArticle 1438-8871 https://hdl.handle.net/1721.1/153504 Nakayama LF, Binotti WW, Link Woite N, Fernandes CO, Alfonso PG, Celi LA, Regatieri CV. The Digital Divide in Brazil and Barriers to Telehealth and Equal Digital Health Care: Analysis of Internet Access Using Publicly Available Data. J Med Internet Res 2023;25:e42483. en_US 10.2196/42483 Journal of Medical Internet Research Creative Commons Attribution An error occurred on the license name. https://creativecommons.org/licenses/by/4.0/ application/pdf JMIR Publications Inc. JMIR Publications |
| spellingShingle | Health Informatics Nakayama, Luis Filipe Binotti, William Warr Link Woite, Naira Fernandes, Chrystinne Oliveira Alfonso, Pia Gabrielle Celi, Leo Anthony Regatieri, Caio Vinicius The Digital Divide in Brazil and Barriers to Telehealth and Equal Digital Health Care: Analysis of Internet Access Using Publicly Available Data |
| title | The Digital Divide in Brazil and Barriers to Telehealth and Equal Digital Health Care: Analysis of Internet Access Using Publicly Available Data |
| title_full | The Digital Divide in Brazil and Barriers to Telehealth and Equal Digital Health Care: Analysis of Internet Access Using Publicly Available Data |
| title_fullStr | The Digital Divide in Brazil and Barriers to Telehealth and Equal Digital Health Care: Analysis of Internet Access Using Publicly Available Data |
| title_full_unstemmed | The Digital Divide in Brazil and Barriers to Telehealth and Equal Digital Health Care: Analysis of Internet Access Using Publicly Available Data |
| title_short | The Digital Divide in Brazil and Barriers to Telehealth and Equal Digital Health Care: Analysis of Internet Access Using Publicly Available Data |
| title_sort | digital divide in brazil and barriers to telehealth and equal digital health care analysis of internet access using publicly available data |
| topic | Health Informatics |
| url | https://hdl.handle.net/1721.1/153504 |
| work_keys_str_mv | AT nakayamaluisfilipe thedigitaldivideinbrazilandbarrierstotelehealthandequaldigitalhealthcareanalysisofinternetaccessusingpubliclyavailabledata AT binottiwilliamwarr thedigitaldivideinbrazilandbarrierstotelehealthandequaldigitalhealthcareanalysisofinternetaccessusingpubliclyavailabledata AT linkwoitenaira thedigitaldivideinbrazilandbarrierstotelehealthandequaldigitalhealthcareanalysisofinternetaccessusingpubliclyavailabledata AT fernandeschrystinneoliveira thedigitaldivideinbrazilandbarrierstotelehealthandequaldigitalhealthcareanalysisofinternetaccessusingpubliclyavailabledata AT alfonsopiagabrielle thedigitaldivideinbrazilandbarrierstotelehealthandequaldigitalhealthcareanalysisofinternetaccessusingpubliclyavailabledata AT celileoanthony thedigitaldivideinbrazilandbarrierstotelehealthandequaldigitalhealthcareanalysisofinternetaccessusingpubliclyavailabledata AT regatiericaiovinicius thedigitaldivideinbrazilandbarrierstotelehealthandequaldigitalhealthcareanalysisofinternetaccessusingpubliclyavailabledata AT nakayamaluisfilipe digitaldivideinbrazilandbarrierstotelehealthandequaldigitalhealthcareanalysisofinternetaccessusingpubliclyavailabledata AT binottiwilliamwarr digitaldivideinbrazilandbarrierstotelehealthandequaldigitalhealthcareanalysisofinternetaccessusingpubliclyavailabledata AT linkwoitenaira digitaldivideinbrazilandbarrierstotelehealthandequaldigitalhealthcareanalysisofinternetaccessusingpubliclyavailabledata AT fernandeschrystinneoliveira digitaldivideinbrazilandbarrierstotelehealthandequaldigitalhealthcareanalysisofinternetaccessusingpubliclyavailabledata AT alfonsopiagabrielle digitaldivideinbrazilandbarrierstotelehealthandequaldigitalhealthcareanalysisofinternetaccessusingpubliclyavailabledata AT celileoanthony digitaldivideinbrazilandbarrierstotelehealthandequaldigitalhealthcareanalysisofinternetaccessusingpubliclyavailabledata AT regatiericaiovinicius digitaldivideinbrazilandbarrierstotelehealthandequaldigitalhealthcareanalysisofinternetaccessusingpubliclyavailabledata |