Katherine Rebecca Biedrzycki

Digital technology use among disadvantaged Australians: implications for equitable consumer participation in digitally-mediated communication and information exchange with health services

OBJECTIVE To present research findings on access to, and use of, digital information and communication technologies (ICTs) by Australians from lower income and disadvantaged backgrounds to determine implications for equitable consumer access to digitally-mediated health services and information. METHODS Focus groups were held in 2008-09 with 80 residents from lower income and disadvantaged backgrounds in South Australia, predominantly of working- and family-formation age (25 to 55 years). Qualitative analysis was conducted on a-priori and emergent themes to describe dominant categories. RESULTS Access to, and use of, computers, the Internet and mobile phones varied considerably in extent, frequency and quality within and across groups due to differences in abilities, resources and life experience. Barriers and facilitators included English literacy (including for native speakers), technological literacy, education, income, housing situation, social connection, health status, employment status, and trust. Many people gained ICT skills by trial and error or help from friends, and only a few from formal programs, resulting in varied skills. CONCLUSION The considerable variation in ICT access and use within lower income and disadvantaged groups must be acknowledged and accommodated by health initiatives and services when delivering digitally-mediated consumer-provider interaction, online health information, or online self-management of health conditions. If services require consumers to participate in a digitally-mediated communication exchange, then we suggest they might support skills and technology acquisition, or provide non-ICT alternatives, in order to avoid exacerbating health inequities.

Vicious cycles: digital technologies and determinants of health in Australia

Digital technologies are increasingly important as ways to gain access to most of the important social determinants of health including employment, housing, education and social networks. However, little is known about the impact of the new technologies on opportunities for health and well-being. This paper reports on a focus group study of the impact of these technologies on people from low socio-economic backgrounds. We use Bourdieus theories of social inequities and the ways in which social, cultural and economic capitals interact to reinforce and reproduce inequities to examine the ways in which digital technologies are contributing to these processes. Six focus group discussions with 55 people were held to examine their access to and views about using digital technologies. These data are analysed in light of Bourdieus theory to determine how peoples existing capitals shape their access to and use of digital technologies and what the implications of exclusion from the technologies are likely to be for the social determinants of health. The paper concludes that some people are being caught in a vicious cycle whereby lack of digital access or the inability to make beneficial use reinforces and amplifies existing disadvantage including low levels of reading and writing literacy. The paper concludes with a consideration of actions health promoters could take to interrupt this cycle and so contribute to reducing health inequities.

Digital Technology Access and Use among Socially and Economically Disadvantaged Groups in South Australia

This paper explores digital technology access and use (computers, Internet and mobile phones) among lower income and disadvantaged groups in Australia. It reports focus group research which identified wide differences in frequency and quality of use, and in skills, confidence and trust. It identifies pathways to digital use (or non-use) related to existing socioeconomic inequities which mean that lack of (or limited) digital access or use creates further barriers to improving the underlying determinants of that use. Technological solutions to the digital divide must therefore be accompanied by a broader digital inclusion approach.

Can a regional government's social inclusion initiative contribute to the quest for health equity?

Despite decades of concern about reducing health inequity, the Commission on the Social Determinants of Health (CSDH) painted a picture of persistent and, in some cases, increasing health inequity. It also made a call for increased evaluation of interventions that might reduce inequities. This paper describes such an intervention-the Social Inclusion Initiative (SII) of the South Australian Government-that was documented for the Social Exclusion Knowledge Network of the CSDH. This initiative is designed to increase social inclusion by addressing key determinants of health inequity-in the study period these were education, homelessness and drug use. Our paper examines evidence from a rapid appraisal to determine whether a social inclusion initiative is a useful aspect of government action to reduce health inequity. It describes achievements in each specific area and the ways they can be expected to affect health equity. Our study highlighted four factors central to the successes achieved by the SII. These were the independent authority and influence of the leadership of the SII, the whole of government approach supported by an overarching strategic plan which sets clear goals for government and the clear and unambiguous support from the highest level of government. We conclude that a social inclusion approach can be valuable in the quest to reduce inequities and that further research on innovative social policy approaches is required to examine their likely impact on health equity.

Partnership in knowledge creation: lessons learned from a researcher–policy actor partnership to co-produce a rapid appraisal case study of south australia’s social Inclusion Initiative

This paper describes a partnership between researchers and policy actors that was developed within a short timeframe to produce a rapid appraisal case study of a government policy initiative – South Australias Social Inclusion Initiative – for the Social Exclusion Knowledge Network of the international Commission on Social Determinants of Health. The paper does not focus on the case study findings or content, but rather on the researcher–policy actor partnership that developed in the process of producing the case study and its report. The paper is set against the broader literature on researcher–policy collaboration and is written to share lessons that may help others quickly establish or improve researcher–policy partnerships. It sets out six key elements for success in a framework for partnership that can meet policy rather than academic timeframes and which can effectively co-produce knowledge that meets both research and policy objectives.

A rapid appraisal case study of South Australia's Social Inclusion Initiative

This case study was undertaken to contribute to the work of the Social Exclusion Knowledge Network (SEKN) of the Commission on Social Determinants of Health (CSDH). The CSDH was established in 2005 by the World Health Organisation to investigate ways in which international, national, regional and local bodies could take action on the social determinants of health. The knowledge networks are one of the main mechanisms by which the CSDH is gathering evidence. This report provides a rapid assessment of the ways in which South Australia’s Social Inclusion Initiative has originated and operated. The report’s layout follows guidelines developed by the SEKN and draws on documentary and interview evidence. The project was conducted between March and June 2007 by researchers at Flinders University of South Australia, in conjunction with senior staff at South Australia’s Social Inclusion Unit, Department of the Premier and Cabinet.