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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.
Background:
Telehealth use has expanded in the primary care safety net, but disparities in telehealth persist, known as the "digital divide." Digital navigation, where patients receive support to enable telehealth access, is a promising strategy, but little is known about its prevalence or implementation.
Objective:
To characterize the current digital navigation landscape of California safety-net primary care clinics and provide recommendations for digital navigation implementation strategies.
Design:
Mixed-methods study, including survey and interview components.
Participants:
Participants working in California primary care safety-net settings, including individuals with roles in clinical care, administration, information technology, and patient support services.
Approach:
We developed a survey and interview guide using the Consolidated Framework for Implementation Research (CFIR). We calculated summary statistics for survey results. We conducted in-depth semi-structured interviews with a subsample of survey participants via video and analyzed transcripts using a mixed inductive-deductive approach to identify features of digital navigation implementation and themes relevant to CFIR.
Key Results:
Of 50 survey participants representing 35 practices, 80% reported their health system had implemented or attempted to implement digital navigation in some form. Qualitative analysis of 16 interviews identified five distinct digital navigation models: (1) integrated staff role, (2) information technology support, (3) dedicated digital navigator, (4) volunteer/external partners, and (5) rural access hub. Challenges to digital navigation implementation included unmet need for access to digital devices and broadband, lack of staff buy-in and digital literacy, and the lack of data-driven screening and referral programs.
Conclusions:
The majority of primary care safety-net sites had some form of digital navigation, ranging from a dedicated navigator to community partnerships. Equitable digital access, a key health-related social need, can be provided through diverse digital navigation models. Ongoing advocacy for device and broadband access and reimbursement mechanisms will be critical for digital navigation implementation and sustainability.
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