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Updated: Mar 19, 2026

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Bridging the Digital Divide with Digital Navigation in the California Safety Net: A Mixed-Methods Study.

Kelsey H Natsuhara1, Nilpa D Shah2,3, Carmen Ma4

  • 1Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.

Journal of General Internal Medicine
|March 18, 2026
PubMed
Summary
This summary is machine-generated.

Digital navigation models are emerging in California safety-net clinics to bridge the digital divide in telehealth. Diverse strategies exist, but challenges like device access and digital literacy require ongoing advocacy for equitable patient care.

Keywords:
implementation (Im)community health centersdigital navigationhealth information technologyhealth professions workforcequality improvement (QI)social determinants of healthtelemedicine

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Area of Science:

  • Health Services Research
  • Digital Health Equity
  • Implementation Science

Background:

  • Telehealth adoption in primary care safety nets is growing, yet disparities persist, creating a digital divide.
  • Digital navigation is a potential solution to improve telehealth access for underserved populations.
  • Limited understanding exists regarding the prevalence and implementation of digital navigation strategies.

Purpose of the Study:

  • To map the digital navigation landscape in California's safety-net primary care clinics.
  • To identify and recommend effective digital navigation implementation strategies.

Main Methods:

  • A mixed-methods study combining surveys and in-depth interviews.
  • Participants included staff from California safety-net primary care settings (clinical, administrative, IT, patient support).
  • The Consolidated Framework for Implementation Research (CFIR) guided survey and interview tool development; qualitative data were analyzed using a mixed inductive-deductive approach.

Main Results:

  • 80% of 35 surveyed practices reported implementing or attempting digital navigation.
  • Five distinct digital navigation models were identified: integrated staff, IT support, dedicated navigator, volunteer/external partners, and rural access hubs.
  • Key challenges included lack of device/broadband access, insufficient staff buy-in, low digital literacy, and inadequate screening/referral programs.

Conclusions:

  • Most safety-net primary care sites utilize some form of digital navigation, demonstrating varied models.
  • Diverse digital navigation approaches can address equitable digital access as a critical health-related social need.
  • Sustained implementation requires advocacy for device/broadband access and favorable reimbursement policies.