{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T22:17:28Z","timestamp":1775341048499,"version":"3.50.1"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"DOI":"10.1038\/s41746-021-00413-8","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T11:03:33Z","timestamp":1615979013000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":463,"title":["Digital inclusion as a social determinant of health"],"prefix":"10.1038","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6517-885X","authenticated-orcid":false,"given":"Cynthia J.","family":"Sieck","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4752-7523","authenticated-orcid":false,"given":"Amy","family":"Sheon","sequence":"additional","affiliation":[]},{"given":"Jessica S.","family":"Ancker","sequence":"additional","affiliation":[]},{"given":"Jill","family":"Castek","sequence":"additional","affiliation":[]},{"given":"Bill","family":"Callahan","sequence":"additional","affiliation":[]},{"given":"Angela","family":"Siefer","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2021,3,17]]},"reference":[{"key":"413_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41746-019-0212-z","volume":"3","author":"WJ Gordon","year":"2020","unstructured":"Gordon, W. J., Landman, A., Zhang, H. & Bates, D. W. Beyond validation: getting health apps into clinical practice. npj Digit. Med. 3, 1\u20136 (2020).","journal-title":"npj Digit. Med."},{"key":"413_CR2","doi-asserted-by":"publisher","first-page":"S162","DOI":"10.1016\/j.amepre.2011.01.005","volume":"40","author":"DK Ahern","year":"2011","unstructured":"Ahern, D. K., Woods, S. S., Lightowler, M. C., Finley, S. W. & Houston, T. K. Promise of and potential for patient-facing technologies to enable meaningful use. Am. J. Prev. Med. 40, S162\u2013S172 (2011).","journal-title":"Am. J. Prev. Med."},{"key":"413_CR3","doi-asserted-by":"publisher","DOI":"10.2196\/10723","volume":"6","author":"T Alessa","year":"2018","unstructured":"Alessa, T., Abdi, S., Hawley, M. S. & de Witte, L. Mobile apps to support the self-management of hypertension: systematic review of effectiveness, usability, and user satisfaction. JMIR mHealth uHealth 6, e10723 (2018).","journal-title":"JMIR mHealth uHealth"},{"key":"413_CR4","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1111\/1753-0407.12606","volume":"10","author":"A Cahn","year":"2018","unstructured":"Cahn, A., Akirov, A. & Raz, I. Digital health technology and diabetes management. J. Diabetes 10, 10\u201317 (2018).","journal-title":"J. Diabetes"},{"key":"413_CR5","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.4883","volume":"18","author":"L Whitehead","year":"2016","unstructured":"Whitehead, L. & Seaton, P. The effectiveness of self-management mobile phone and tablet apps in long-term condition management: a systematic review. J. Med. Internet Res. 18, e97 (2016).","journal-title":"J. Med. Internet Res."},{"key":"413_CR6","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-007270","volume":"5","author":"E Cottrell","year":"2015","unstructured":"Cottrell, E., Cox, T., O\u2019Connell, P. & Chambers, R. Patient and professional user experiences of simple telehealth for hypertension, medication reminders and smoking cessation: a service evaluation. BMJ Open 5, e7270 (2015).","journal-title":"BMJ Open"},{"key":"413_CR7","doi-asserted-by":"crossref","unstructured":"Shimada S. L., et al. Patient-provider secure messaging in VA: variations in adoption and association with urgent care utilization. Med. Care S21\u2013S28 (2013).","DOI":"10.1097\/MLR.0b013e3182780917"},{"key":"413_CR8","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1055\/s-0039-1677722","volume":"10","author":"AS McAlearney","year":"2019","unstructured":"McAlearney, A. S. et al. Empowering patients during hospitalization: perspectives on inpatient portal use. Appl. Clin. Inform. 10, 103\u2013112 (2019).","journal-title":"Appl. Clin. Inform."},{"key":"413_CR9","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1007\/s40520-016-0600-z","volume":"29","author":"TJ Mattingly","year":"2017","unstructured":"Mattingly, T. J., Tom, S. E., Stuart, B. & Onukwugha, E. Examining patient-provider relationship (PPR) quality and patient activation in the Medicare population. Aging Clin. Exp. Res. 29, 543\u2013548 (2017).","journal-title":"Aging Clin. Exp. Res."},{"key":"413_CR10","unstructured":"Tomer, A., Fishbane, L., Siefer, A., Callahan, B. Digital Prosperity: How Broadband can Delvier Health and Equity to All Communities. (Metropolitan Infrastructure Initiative: Brookings Institution, 2020)."},{"key":"413_CR11","unstructured":"Gibbons, C. Digital Access Disparities: Policy and Practice Overview. Panel Discussion, Digital Skills and Connectivity as Social Determinants of Health. Sheon, A Conference Report: Digital Skills: A Hidden \u201cSuper\u201d Social Determinant of Health: Interdisciplinary Association for Population Health Science. (2018)."},{"key":"413_CR12","unstructured":"Schartman-Cycyk, S., Meisser, K. Bridging the gap: what affordable, uncapped internet means for digital inclusion. In (ed Beacon M.) (2017)."},{"key":"413_CR13","unstructured":"National Digital Inclusion Alliance. https:\/\/www.digitalinclusion.org\/definitions\/ (2019)."},{"key":"413_CR14","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1093\/jamia\/ocx020","volume":"24","author":"AT Perzynski","year":"2017","unstructured":"Perzynski, A. T. et al. Patient portals and broadband internet inequality. J. Am. Med. Inform. Assoc. 24, 927\u2013932 (2017).","journal-title":"J. Am. Med. Inform. Assoc."},{"key":"413_CR15","unstructured":"Raine, L. Digital Divides 2016. In: Pew Research Center, 2016."},{"key":"413_CR16","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1093\/jamia\/ocz023","volume":"26","author":"LV Grossman","year":"2019","unstructured":"Grossman, L. V. et al. Interventions to increase patient portal use in vulnerable populations: a systematic review. J. Am. Med. Inform. Assoc. 26, 855\u2013870 (2019).","journal-title":"J. Am. Med. Inform. Assoc."},{"key":"413_CR17","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1377\/hlthaff.2020.00447","volume":"39","author":"KR Sundar","year":"2020","unstructured":"Sundar, K. R. A patient with COVID-19 is left behind as care goes virtual. Health Aff. 39, 1453\u20131455 (2020).","journal-title":"Health Aff."},{"key":"413_CR18","doi-asserted-by":"publisher","first-page":"S115","DOI":"10.1097\/MLR.0000000000001092","volume":"57","author":"X Zhang","year":"2019","unstructured":"Zhang, X. et al. Role of health information technology in addressing health disparities: patient, clinician, and system perspectives. Med. Care 57, S115\u2013S120 (2019).","journal-title":"Med. Care"},{"key":"413_CR19","unstructured":"Sheon A., Carrol L. How can health systems leverage technology to engage patients?. in (ed Marx E. W.) Voices of Innovation: Fulfilling the Promise of Information Technology in Healthcare. (Taylor and Francis, Washington, DC, 2018)."},{"key":"413_CR20","doi-asserted-by":"publisher","DOI":"10.2196\/resprot.6355","volume":"5","author":"AS McAlearney","year":"2016","unstructured":"McAlearney, A. S. et al. High touch and high tech (HT2) proposal: transforming patient engagement throughout the continuum of care by engaging patients with portal technology at the bedside. JMIR Res. Protoc. 5, e221 (2016).","journal-title":"JMIR Res. Protoc."},{"key":"413_CR21","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.1001\/journalofethics.2017.19.11.stas2-1711","volume":"19","author":"B Van Winkle","year":"2017","unstructured":"Van Winkle, B., Carpenter, N. & Moscucci, M. Why aren\u2019t our digital solutions working for everyone? AMA J. Ethics 19, 1116\u20131124 (2017).","journal-title":"AMA J. Ethics"},{"key":"413_CR22","first-page":"S33","volume":"3","author":"K Harris","year":"2019","unstructured":"Harris, K., Jacobs, G. & Reeder, J. Health systems and adult basic education: a critical partnership in supporting digital health literacy. Health Lit. Res. Pract. 3, S33\u2013S36 (2019).","journal-title":"Health Lit. Res. Pract."},{"key":"413_CR23","doi-asserted-by":"publisher","DOI":"10.2196\/diabetes.6751","volume":"2","author":"AR Sheon","year":"2017","unstructured":"Sheon, A. R., Bolen, S. D., Callahan, B., Shick, S. & Perzynski, A. T. Addressing disparities in diabetes management through novel approaches to encourage technology adoption and use. JMIR Diabetes 2, e16 (2017).","journal-title":"JMIR Diabetes"},{"key":"413_CR24","unstructured":"Commission FC. Lifeline Support for Affordable Communications. Secondary Lifeline Support for Affordable Communications. https:\/\/www.fcc.gov\/consumers\/guides\/lifeline-support-affordable-communications (2020)."},{"key":"413_CR25","unstructured":"Administration. AANTaI. Final report: social and economic impacts of the Broadband Technology Opportunities Program. (2014)."},{"key":"413_CR26","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.telpol.2018.04.001","volume":"43","author":"K Jayakar","year":"2019","unstructured":"Jayakar, K. & Park, E.-A. Reforming the lifeline program: regulatory federalism in action? Telecommun. Policy 43, 67\u201375 (2019).","journal-title":"Telecommun. Policy"}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-021-00413-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-021-00413-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-021-00413-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T18:47:41Z","timestamp":1670093261000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-021-00413-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,17]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["413"],"URL":"https:\/\/doi.org\/10.1038\/s41746-021-00413-8","relation":{},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,17]]},"assertion":[{"value":"19 March 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 December 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"52"}}