{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T16:37:48Z","timestamp":1784306268920,"version":"3.55.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T00:00:00Z","timestamp":1720396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Digital health has the potential to expand health care and improve outcomes for patients\u2014particularly for those with challenges to accessing in-person care. The acceleration of digital health (and particularly telemedicine) prompted by the Coronavirus-19 (COVID-19) pandemic facilitated continuity of care in some settings but left many health systems ill-prepared to address digital uptake among patients from underserved backgrounds, who already experience health disparities. As use of digital health grows and the digital divide threatens to widen, healthcare systems must develop approaches to evaluate patients\u2019 needs for digital health inclusion, and consequentially equip patients with the resources needed to access the benefits of digital health. However, this is particularly challenging given the absence of any standardized, validated multilingual screening instrument to assess patients\u2019 readiness for digital healthcare that is feasible to administer in already under-resourced health systems. This perspective is structured as follows: (1) the need for digital health exclusion risk screening, (2) our convening as a group of stakeholders, (3) our review of the known digital health screening tools and our assessment, (4) formative work with patients regarding their perceptions on language and concepts in the digital health screening tools, and (5) conclusion with recommendations for digital health advocates generated by this collaborative of digital health researchers and operations leaders. There is a need to develop a brief, effective tool to screen for digital health use that can be widely implemented in diverse populations. We include lessons learned from our experiences in developing and testing risk of digital health exclusion screening questions in our respective health systems (e.g., patient perception of questions and response options). Because we recognize that health systems across the country may be facing similar challenges and questions, this perspective aims to inform ongoing efforts in developing health system digital exclusion screening tools and advocate for their role in advancing digital health equity.<\/jats:p>","DOI":"10.3389\/fpubh.2024.1421129","type":"journal-article","created":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T04:46:41Z","timestamp":1720414001000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Lessons learned from a multi-site collaborative working toward a digital health use screening tool"],"prefix":"10.3389","volume":"12","author":[{"given":"Ann M.","family":"Hernandez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine C.","family":"Khoong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neytali","family":"Kanwar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Lopez-Solano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge A.","family":"Rodriguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"De Marchis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oanh Kieu","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandra","family":"Casillas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,7,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e10723","DOI":"10.2196\/10723","article-title":"Mobile apps to support the self-Management of Hypertension: systematic review of effectiveness, usability, and user satisfaction","volume":"6","author":"Alessa","year":"2018","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e13645","DOI":"10.2196\/13645","article-title":"Smartphone apps to support self-Management of Hypertension: review and content analysis","volume":"7","author":"Alessa","year":"2019","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e26189","DOI":"10.2196\/26189","article-title":"The impact of digital patient portals on health outcomes, system efficiency, and patient attitudes: updated systematic literature review","volume":"23","author":"Carini","year":"2021","journal-title":"J Med Internet Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1016\/j.pop.2022.04.002","article-title":"The state of telehealth before and after the COVID-19 pandemic","volume":"49","author":"Shaver","year":"2022","journal-title":"Prim Care"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1056\/CAT.20.0123","article-title":"Addressing equity in telemedicine for chronic disease management during the COVID-19 pandemic","volume":"4","author":"Nouri","year":"2020","journal-title":"Nejm Catal Innov Care Deliv"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1093\/jamia\/ocaa217","article-title":"Telemedicine and healthcare disparities: a cohort study in a large healthcare system in new York City during COVID-19","volume":"28","author":"Chunara","year":"2020","journal-title":"J Am Med Inform Assoc JAMIA"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1001\/jamainternmed.2020.5928","article-title":"Trends in outpatient care delivery and telemedicine during the COVID-19 pandemic in the US","volume":"181","author":"Patel","year":"2021","journal-title":"JAMA Intern Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e210264","DOI":"10.1001\/jamahealthforum.2021.0264","article-title":"Inequities in technology contribute to disparities in COVID-19 vaccine distribution","volume":"2","author":"Press","year":"2021","journal-title":"JAMA Health Forum"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1370\/afm.2823","article-title":"Centering health equity in telemedicine","volume":"20","author":"Lyles","year":"2022","journal-title":"Ann Fam Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e16951","DOI":"10.2196\/16951","article-title":"The use of Technology for Communicating with Clinicians or seeking health information in a multilingual urban cohort: cross-sectional survey","volume":"22","author":"Khoong","year":"2020","journal-title":"J Med Internet Res"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/jamia\/ocaa234","article-title":"Patient interest in and barriers to telemedicine video visits in a multilingual urban safety-net system","volume":"28","author":"Khoong","year":"2020","journal-title":"J Am Med Inform Assoc JAMIA"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1377\/hlthaff.2020.00823","article-title":"Disparities in telehealth use among California patients with limited English proficiency","volume":"40","author":"Rodriguez","year":"2021","journal-title":"Health Aff Proj Hope"},{"key":"ref13","unstructured":""},{"key":"ref14","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1038\/s41746-021-00413-8","article-title":"Digital inclusion as a social determinant of health","volume":"4","author":"Sieck","year":"2021","journal-title":"Npj Digit Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1001\/jama.2024.1628","article-title":"Digital redlining\u2014the invisible structural determinant of health","volume":"331","author":"Wang","year":"2024","journal-title":"JAMA"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1377\/forefront.20230221.857308","article-title":"Developing National Social Care Standards","author":"Gottlieb","year":"2023","journal-title":"Health Aff Forefr"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"67","DOI":"10.3233\/ADR-210024","article-title":"Telehealth literacy as a social determinant of health: a novel screening tool to support vulnerable patient equity","volume":"6","author":"Gillie","year":"2022","journal-title":"J Alzheimers Dis Rep"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2381","DOI":"10.1001\/jama.2020.7858","article-title":"Digital health equity as a necessity in the 21st century cures act era","volume":"323","author":"Rodriguez","year":"2020","journal-title":"JAMA"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"21","DOI":"10.18865\/ed.32.1.21","article-title":"Electronic health literacy among linguistically diverse patients in the Los Angeles County safety net health system","volume":"32","author":"Valdovinos","year":"2022","journal-title":"Ethn Dis"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e507","DOI":"10.2196\/jmir.8.4.e27","article-title":"eHEALS: the eHealth literacy scale","volume":"8","author":"Norman","year":"2006","journal-title":"J Med Internet Res"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e36043","DOI":"10.2196\/36043","article-title":"A 3-item measure of digital health care literacy: development and validation study","volume":"6","author":"Nelson","year":"2022","journal-title":"JMIR Form Res"},{"key":"ref22","unstructured":"Veterans Health Administration2023"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1177\/0733464816642582","article-title":"A new tool for assessing Mobile device proficiency in older adults: the Mobile device proficiency questionnaire","volume":"37","author":"Roque","year":"2018","journal-title":"J Appl Gerontol Off J South Gerontol Soc"},{"key":"ref24","unstructured":"NIH Natl Cancer Inst2023"},{"key":"ref25","unstructured":"BureauUC\n          2023"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e27","DOI":"10.2196\/jmir.6709","article-title":"Development of the digital health literacy instrument: measuring a broad Spectrum of health 1.0 and health 2.0 skills","volume":"19","author":"van der Vaart","year":"2017","journal-title":"J Med Internet Res"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1097\/CIN.0000000000000146","article-title":"Testing reliability and validity of the eHealth literacy scale (eHEALS) for older adults recruited online","volume":"33","author":"Chung","year":"2015","journal-title":"Comput Inform Nurs CIN"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"105124","DOI":"10.1016\/j.ijmedinf.2023.105124","article-title":"Sociodemographic determinants of digital health literacy: a systematic review and meta-analysis","volume":"177","author":"Estrela","year":"2023","journal-title":"Int J Med Inform"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e14250","DOI":"10.2196\/14250","article-title":"Assessing Mobile phone digital literacy and engagement in user-centered Design in a Diverse, safety-net population: mixed methods study","volume":"7","author":"Nouri","year":"2019","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref30","unstructured":"Medicare advantage and part D final rule (CMS-4201-F)2024"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1146\/annurev-publhealth-071521-023913","article-title":"Multilevel determinants of digital health equity: a literature synthesis to advance the field","volume":"44","author":"Lyles","year":"2023","journal-title":"Annu Rev Public Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1421129\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T04:46:44Z","timestamp":1720414004000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1421129\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,8]]},"references-count":31,"alternative-id":["10.3389\/fpubh.2024.1421129"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1421129","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,8]]},"article-number":"1421129"}}