How to make sure digital health interventions work for low-income patients

By Jonah Comstock
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Taylannas SpeechMedDigital health interventions have tremendous potential to help vulnerable and underserved populations, but they're rarely suited for those populations out of the box, according to a new California HealthCare Foundation report authored by Health Populi blogger Jane Sarasohn-Kahn. Instead, digital health developers need to consider the particular needs of low-income, low-literacy, ESL, and Medicaid populations in creating their interventions.

"Importantly, low-income consumers are harder to reach and to serve in the traditional model of face-to-face care during typical working hours," Sarasohn-Kahn writes. "They are more likely than others to lack stable housing, transportation, and work schedule flexibility. Many lack facility in English, and some are socially isolated. People in the safety-net population tend to have less consistent access to WiFi, which is increaseingly becoming a necessity for connecting with education, health, and human service."

In her report, Sarasohn-Kahn outlines a list of existing technologies that have been successful in connecting with underserved populations, including text messaging, portals and kiosks, video visits and other kinds of telehealth, passive data collection, and platforms that combine health services with other social services. Extrapolating from those success stories, she presents a list of strategies for helping these populations.

Number one is to not make assumptions about vulnerable populations' needs and capabilities. This includes technological capabilities: Some interventions fail because they assume populations have more consistent access to WiFi or data than they have, and sometimes it might even be cost-effective to pay for users' data plans in some interventions. It also includes health literacy and language literacy. One anecdote in the report concerns a bilingual patient who mistook the English adjective "once" for the Spanish number "once" and took 11 pills -- 10 more than her doctor prescribed.

Second, it's especially important to build the trust of underserved individuals, who might have a history of bad experiences with government and social support programs that don't follow through. Working through the local community, including church leaders, city councillors, educators, and doctors, can help bridge the way to that trust. 

Third, Sarasohn-Kahn advocates addressing the social determinants of health. That is, as Shawn Nason, former chief innovation officer of Xavier University said in the report, "don't talk to me about walking 10,000 steps a day when I'm a single mom with four kids, working two jobs". Programs that work for underserved populations will be integrated with other programs that address their most basic needs first, enabling them to focus on their health. 

Finally, the report predicts that the move from fee-for-service to value-based care will necessarily enhance the attention paid to helping vulnerable populations, because they do contribute disproportionately to healthcare costs. As such, we'll naturally see a focus on understanding when interventions work for vulnerable populations, scaling those that do, and adapting those that don't.