CTSI project is helping to bridge the digital divide

One of the many effects of the COVID-19 pandemic on healthcare was increased reliance on technology, for everything from doctors’ appointments to virtual visits with friends and family. While many people embraced these technological shifts, not everyone could take advantage of them if they lacked access to or knowledge of the internet. It is not surprising that older adults were the segment of the population that found themselves at the highest disadvantage.

Closing the gulf between those who have ready access to computers and the internet and those who do not is the goal of a community-driven project providing older adults with one-on-one coaching on internet access and use of tablets provided free of cost.

The Digital Divide project involves a collaboration between the UB Clinical and Translational Science Institute (CTSI) Recruitment and Special Populations Core and Canopy of Neighbors, a nonprofit organization dedicated to creating new pathways to aging well and aging independently in community. Further, Verizon partnered by providing six months of a hotspot wi-fi broadband service at reduced cost.

‘The digital divide was creating second-class citizens’

CTSI Recruitment and Special Populations Core Director Teresa Quattrin, MD, UB Distinguished Professor, Associate Dean for Research Integration, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, says that technology equity has emerged as a key issue creating health and social inequities, even more so as a result of the pandemic.

“It was very apparent that the digital divide was creating second class citizens — those who did not have access to broadband, the internet, or wi-fi, and also those who may not have the means to actually learn how to navigate a world unfamiliar for them,” Quattrin explains.

A CTSI-led in-person focus group of 35 predominantly BIPOC (Black, Indigenous and People of Color) adults living in the City of Buffalo confirmed that the issue was of particular importance locally: 66% answered that they wish to or use the internet for healthcare, including patient portals and telehealth, and 71% answered that they know of someone in their community who cannot access the internet.

Focus group participants suggested that personally tailored lessons could be a way of bridging the divide. The project also benefitted from input from meetings with Chitra Rajan, PhD, Associate Vice President, Research Advancement, Research and Economic Development, and the Associate Deans for Research in the College of Arts and Sciences, Schools of Nursing, Education, Engineering, and Public Health and Health Professions. Sasha Yerkovich, the Executive Director of Canopy of Neighbors provided invaluable expertise and connections with potential participants. Funding for the focus groups was provided from the Moving Forward Together initiative (formerly known as Build Back Better); the Western New York Digital Equity Coalition funded the present project.

‘Digital literacy can be life-saving’

“Early on in the pandemic, we identified how social isolation was affecting folks, particularly older adults,” says CTSI Special Populations Task Leader Renee Cadzow, PhD, Research Associate Professor, Volunteer, Department of Pediatrics, Jacobs School, and Associate Professor and Associate Director/Chair, Center for Doctoral Studies and Research, D'Youville University. “Digital ways of communicating were really prioritized, but that was leaving our older adults without that access. It further compounded their social isolation.”

In her role with Canopy of Neighbors, Yerkovich has seen first-hand the results of the digital divide on the elder population.

“In an increasingly digital world, and in light of the recent pandemic, digital literacy can be life-saving,” she says. “Imagine a whole constituency of people who could not Zoom in order to relieve social isolation and then fell into depression; could not order groceries online; could not make vaccination appointments; could not keep up with changing medical recommendations on CDC and state websites; and could not engage in telehealth appointments.”

Yerkovich notes that digital technology has expanded to wearables that measure blood sugar and heart arrhythmias, detect falls, and alleviate loneliness. Those who cannot afford access to such devices or do not know how to use them are being left behind.

When Yerkovich was contacted by CTSI Special Populations Coordinator Andy Strohmeier, MEd, she went on a listening tour of Canopy of Neighbors members to find participants who would benefit from being part of the project. 

“The need for this type of boots-on-the-ground project and research is great,” Yerkovich says. “We must mitigate the negative effects that digital inequality has on the mental and physical health outcomes. These negative impacts affect our healthcare system, our economy, and the basic dignity of our elder population. As the number of older adults increases in the coming years, we cannot write off this inequity and turn our backs to this suffering.”

Getting connected

Strohmeier, CTSI Clinical Recruitment Coordinator Ashley Regling, MA, and CTSI Senior Research Administrator Erin O’Byrne, MBA, found varied levels of tech experience among the participants. “Some had only ever worked with computers in the 1990s, and often just spreadsheet programs for their jobs,” Strohmeier says. “They were not used to having any type of technology to help their lives.”

Tony Schroeder, a Buffalo resident, is one of the current Digital Divide project participants. His digital experience was limited. “I basically knew how to be a kid in school — how to look things up; just really basic stuff,” Tony says. His sessions empowered him with being able to select his primary care provider, to explore the world of YouTube and Wikipedia, and to “get connected with the whole social world out there.”

Another participant, Helen Westmoreland, felt trepidation when it came to digital devices. Now, this Buffalo resident is comfortable using the tablet on her own. In fact, she encourages others to jump in and get started. After her coaching she would tell her peers that “there is no reason to fear.” Westmoreland says she is now ready for her next step — using her healthcare provider’s online patient portal.

“Every week, we are building up their confidence and independence,” Strohmeier says. “One of my participants has a folder full of questions every single week — ‘Can you please teach me how to do this?’"

Health was the starting point, including telehealth and patient portals, but the need to connect with friends and family members quickly emerged and was embraced by the UB team.

“We had a very powerful moment when one of my elders was able to Zoom with a friend in Canada,” Regling shared. “There were tears of joy from both women because they had not seen each other since the beginning of the pandemic.”

“Our experiences with the participants have underscored the fact that digital equity means having access to the digital world for many aspects that better our lives, from healthcare to connecting with loved ones,” adds O’Byrne.

Digital Divide organizers are now considering next steps. Quattrin says these “need to account for generalizability and cost-effectiveness.” This includes building on the current one-on-one format to delivery of lessons in small groups. Also being explored is the idea of having the curriculum implemented by community health workers and other outreach workers, who are already addressing social determinants of health, and the possibility of a “train the trainer” model.

“Once we teach people about the technology, then they might be able to use these applications to be able to take better care of their chronic problems,” Quattrin says. “We feel strongly that there has to be equity on all levels.”

For more information on the CTSI’s Recruitment and Special Populations Core, visit buffalo.edu/ctsi/cores/recruitment.html and for questions regarding the Digital Divide project, contact Strohmeier at 716-829-2223 or awstrohm@buffalo.edu.