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Due to health disparities LGBT older adults may have more health care needs, but they are likely to have less informal sources of support. While efforts have been made to serve LGBT older adults, traditional forms of in person outreach and service may still be inaccessible to those living in rural areas, with restricted mobility, due to lack of transportation, during inclement weather, or in public health situations as the Covid-19 pandemic. We conducted focus group discussions to understand the role of virtual outreach in serving LGBT individuals' needs in their later years of life. Study participants expressed a desire for dating, community, aging in place, and affirming health care. However, their experience of internalized and institutional homophobia and ageism may act as barriers in fulfilling those needs. A dedicated virtual space has the potential to overcome these barriers by facilitating online get-togethers, support groups, dating events, having coming out resources, and exchanging information on LGBT friendly health services. Having a space to express their generativity may make such virtual services more empowering. Lack of technological access and privacy concerns may hinder the use of virtual services but can be overcome with training and education.

Wersja artykułu znajdująca się w innym repozytorium z wolnym dostępem. Oryginalny artykuł dostępny na licencji CC http://dx.doi.org/10.5210/fm.v25i7.10842 2020 marks the 25th anniversary of the “digital divide.” Although a quarter century has passed, legacy digital inequalities continue, and emergent digital inequalities are proliferating. Many of the initial schisms identified in 1995 are still relevant today. Twenty-five years later, foundational access inequalities continue to separate the digital haves and the digital have-nots within and across countries. In addition, even ubiquitous-access populations are riven with skill inequalities and differentiated usage. Indeed, legacy digital inequalities persist vis-à-vis economic class, gender, sexuality, race and ethnicity, aging, disability, healthcare, education, rural residency, networks, and global geographies. At the same time, emergent forms of inequality now appear alongside legacy inequalities such that notions of digital inequalities must be continually expanded to become more nuanced. We capture the increasingly complex and interrelated nature of digital inequalities by introducing the concept of the “digital inequality stack.” The concept of the digital inequality stack encompasses access to connectivity networks, devices, and software, as well as collective access to network infrastructure. Other layers of the digital inequality stack include differentiated use and consumption, literacies and skills, production and programming, etc. When inequality exists at foundational layers of the digital inequality stack, this often translates into inequalities at higher levels. As we show across these many thematic foci, layers in the digital inequality stack may move in tandem with one another such that all layers of the digital inequality stack reinforce disadvantage.

Wersja artykułu znajdująca się w innym repozytorium z wolnym dostępem. Oryginalny artykuł dostępny na licencji CC http://dx.doi.org/10.5210/fm.v25i7.10844 Marking the 25th anniversary of the “digital divide,” we continue our metaphor of the digital inequality stack by mapping out the rapidly evolving nature of digital inequality using a broad lens. We tackle complex, and often unseen, inequalities spawned by the platform economy, automation, big data, algorithms, cybercrime, cybersafety, gaming, emotional well-being, assistive technologies, civic engagement, and mobility. These inequalities are woven throughout the digital inequality stack in many ways including differentiated access, use, consumption, literacies, skills, and production. While many users are competent prosumers who nimbly work within different layers of the stack, very few individuals are “full stack engineers” able to create or recreate digital devices, networks, and software platforms as pure producers. This new frontier of digital inequalities further differentiates digitally skilled creators from mere users. Therefore, we document emergent forms of inequality that radically diminish individuals’ agency and augment the power of technology creators, big tech, and other already powerful social actors whose dominance is increasing.

In this special issue of First Monday, Global perspectives on digital inequalities and solutions to them we bring together scholars from five continents to offer a vista of the field of digital inequalities at the close of the 25th anniversary of the “digital divide.” We have chosen First Monday to publish our scholarship thanks to the foundational work in open access publishing by Edward J. Valauskas, Chief Editor and Founder. First Monday’s approach to sharing knowledge and information free of charge to authors and readers epitomizes the ideals of digital inclusion — a spirit of using technology for social benefit and good that is evermore important as digital technologies grow and spread into every facet of life.\ud \ud Setting the stage for the rest of the special issue, we open with two articles that offer a panorama of digital inequalities past, present, and future. After offering this wide angle of vision, six additional studies train their analytic foci on several major themes with policy implications: inequalities in use, skills, education, and learning. The extended discussion of policy culminates in two further studies on public policy across the Americas. At the time of writing, we are several months into the COVID-19 pandemic; therefore we close this special issue with a timely inquiry of how digital inequalities are being magnified by the pandemic that is creating new forms of vulnerability.

The ubiquity and convenience of smartphones carries great potential for collecting patient-reported data to address many gaps in research, especially those that rely on ongoing, real-time data collection. Health care apps have often suffered from low utility due to lack of consideration of the needs of multiple stakeholders. We employed an iterative user-centered design approach to create the myEczema smartphone application (app) to study the burden of disease of atopic dermatitis. We outline below the steps we took for developing myEczema for multiple stakeholders, including patients, clinicians, and researchers.

Background Heart failure (HF) is a chronic condition affecting nearly 5.7 million Americans and is a leading cause of morbidity and mortality. With an aging population, the cost associated with managing HF is expected to more than double from US $31 billion in 2012 to US $70 billion by 2030. Readmission rates for HF patients are high—25% are readmitted at 30 days and nearly 50% at 6 months. Low medication adherence contributes to poor HF management and higher readmission rates. Remote telehealth monitoring programs aimed at improved medication management and adherence may improve HF management and reduce readmissions. Objective The primary goal of this randomized controlled pilot study is to compare the MedSentry remote medication monitoring system versus usual care in older HF adult patients who recently completed a HF telemonitoring program. We hypothesized that remote medication monitoring would be associated with fewer unplanned hospitalizations and emergency department (ED) visits, increased medication adherence, and improved health-related quality of life (HRQoL) compared to usual care. Methods Participants were randomized to usual care or use of the remote medication monitoring system for 90 days. Twenty-nine participants were enrolled and the final analytic sample consisted of 25 participants. Participants completed questionnaires at enrollment and closeout to gather data on medication adherence, health status, and HRQoL. Electronic medical records were reviewed for data on baseline classification of heart function and the number of unplanned hospitalizations and ED visits during the study period. Results Use of the medication monitoring system was associated with an 80% reduction in the risk of all-cause hospitalization and a significant decrease in the number of all-cause hospitalization length of stay in the intervention arm compared to usual care. Objective device data indicated high adherence rates (95%-99%) among intervention group participants despite finding no significant difference in self-reported adherence between study arms. The intervention group had poorer heart function and HRQoL at baseline, and HRQoL declined significantly in the intervention group compared to controls. Conclusions The MedSentry medication monitoring system is a promising technology that merits continued development and evaluation. The MedSentry medication monitoring system may be useful both as a standalone system for patients with complex medication regimens or used to complement existing HF telemonitoring interventions. We found significant reductions in risk of all-cause hospitalization and the number of all-cause length of stay in the intervention group compared to controls. Although HRQoL deteriorated significantly in the intervention group, this may have been due to the poorer HF-functioning at baseline in the intervention group compared to controls. Telehealth medication adherence technologies, such as the MedSentry medication monitoring system, are a promising method to improve patient self-management,the quality of patient care, and reduce health care utilization and expenditure for patients with HF and other chronic diseases that require complex medication regimens. Trial Registration ClinicalTrials.gov NCT01814696; https://clinicaltrials.gov/ct2/show/study/NCT01814696 (Archived by WebCite® at http://www.webcitation.org/6giqAVhno)

BackgroundPeople aging with HIV are living with increased risk for functional decline compared with uninfected adults of the same age. Early preclinical changes in biomarkers in middle-aged individuals at risk for mobility and functional decline are needed. ObjectiveThis pilot study aims to compare measures of free-living activity with lab-based measures. In addition, we aim to examine differences in the activity level and patterns by HIV status. MethodsForty-six men (23 HIV+, 23 HIV−) currently in the MATCH (Muscle and Aging Treated Chronic HIV) cohort study wore a consumer-grade wristband accelerometer continuously for 3 weeks. We used free-living activity to calculate the gait speed and time spent at different activity intensities. Accelerometer data were compared with lab-based gait speed using the 6-minute walk test (6-MWT). Plasma biomarkers were measured and biobehavioral questionnaires were administered. ResultsHIV+ men more often lived alone (P=.02), reported more pain (P=.02), and fatigue (P=.048). In addition, HIV+ men had lower blood CD4/CD8 ratios (P

LGBT older adults constitute a rare population and so are methodologically difficult to recruit. Due to stigma, many of them may not disclose their sexual/gender identity, which makes it challenging for researchers to reach out to them. Due to history of discrimination, LGBT older adults may not trust researchers. The purpose of this presentation is to discuss strategies used to recruit LGBT older adults to a study on exploring the idea of an online senior center for LGBT older adults in Massachusetts. Building a rapport with community stakeholders, developing trust and having LGBT older adults themselves as part of the research team were important tools to help overcome these challenges. LGBT older adults are very diverse and focused efforts should be made to recruit them from various racial/ethnic backgrounds, rural areas; also, those who are not publicly open about their identity, and who are home bound due to restricted mobility.

BACKGROUND People aging with HIV are living with increased risk for functional decline compared with uninfected adults of the same age. Early preclinical changes in biomarkers in middle-aged individuals at risk for mobility and functional decline are needed. OBJECTIVE This pilot study aims to compare measures of free-living activity with lab-based measures. In addition, we aim to examine differences in the activity level and patterns by HIV status. METHODS Forty-six men (23 HIV+, 23 HIV−) currently in the MATCH (Muscle and Aging Treated Chronic HIV) cohort study wore a consumer-grade wristband accelerometer continuously for 3 weeks. We used free-living activity to calculate the gait speed and time spent at different activity intensities. Accelerometer data were compared with lab-based gait speed using the 6-minute walk test (6-MWT). Plasma biomarkers were measured and biobehavioral questionnaires were administered. RESULTS HIV+ men more often lived alone (P=.02), reported more pain (P=.02), and fatigue (P=.048). In addition, HIV+ men had lower blood CD4/CD8 ratios (P CONCLUSIONS Accelerometer-based assessment of gait speed and activity patterns are lower for asymptomatic men living with HIV compared with uninfected controls and may be useful as preclinical digital biomarkers that precede differences captured in lab-based measures.

Human immunodeficiency virus (HIV)-infected individuals are at increased risk of age-associated functional impairment, even with effective antiretroviral therapy (ART). Whether accelerated aging occurs in chronic HIV infection and the biological mechanisms that underlay aging with chronic HIV infection remains unclear. We undertook a prospective observational study of 170 middle-aged, HIV-infected ambulatory men and women with CD4+ T-cell counts of at least 350 per ml and undetectable plasma viremia while on effective antiretroviral therapy, and uninfected control participants. We measured biomarkers for inflammation and immune activation, fatigue, the Veterans Aging Cohort Study (VACS) mortality index, and conducted physical function assessment and accelerometer tracking. A subset of participants also received a skeletal muscle biopsy and computerized tomography scan. Compared to the uninfected, HIV+ participants displayed increased immune activation (P

Slower gait speed is a well-established indicator for increased risk of morbidity and mortality. However, gold standard measurement methods like the six-minute walk test (6MWT), are difficult to use in a clinical setting and may not capture important differences in free-living, volitional activity. We enrolled 46 men (23 HIV+, 23 HIV-) from a prospective observational study (MATCH) of men and women, 50–65 years old. Participants wore an activity tracker (i.e., Nokia Pulse Ox) for three weeks. Tracker data was used to create average gait speed and a measure of percent time at quartiles of maximum observed gait speed. Lab-based, 6MWT gait speed did not differ significantly by HIV status. Free-living, tracker assessed gait speed was significantly slower among HIV+ compared to uninfected participants. HIV+ participants also spent more time at lower activity levels. Free-living gait speed may provide an important digital biomarker of risks not detected by traditional lab-based measures.

While the field of digital inequality continues to expand in many directions, the relationship between digital inequalities and other forms of inequality has yet to be fully appreciated. This article invites social scientists in and outside the field of digital media studies to attend to digital inequality, both as a substantive problem and as a methodological concern. The authors present current research on multiple aspects of digital inequality, defined expansively in terms of access, usage, skills, and self-perceptions, as well as future lines of research. Each of the contributions makes the case that digital inequality deserves a place alongside more traditional forms of inequality in the twenty-first century pantheon of inequalities. Digital inequality should not be only the preserve of specialists but should make its way into the work of social scientists concerned with a broad range of outcomes connected to life chances and life trajectories. As we argue, the significance of digital inequalities is...

Arguments that mistrust about information security will deter patients from embracing telehealth care ignore patients' willingness to take on risk in the pursuit of health benefits and the role physicians will play in encouraging adoption.

BACKGROUND: Telemedicine may have the possibility to provide better access to healthcare delivery for the citizens. Telemedicine in arctic remote areas must be tailored according to the needs of the local population. Therefore, we need more knowledge about their needs and their view of telemedicine.OBJECTIVE: The aim of this study has been to explore how citizens living in the Greenlandic settlements experience the possibilities and challenges of telemedicine when receiving healthcare delivery in everyday life.MATERIALS AND METHODS: Case study design was chosen as the overall research design. Qualitative interviews (n = 14) were performed and participant observations (n = 80 h) carried out in the local healthcare center in the settlements and towns. A logbook was kept and updated each day during the field research in Greenland. Observations were made of activities in the settlements.FINDINGS: Data collected on citizens' views about the possibilities of using telemedicine in Greenland revealed the following findings: Greenlandic citizens are positive toward telemedicine, and telemedicine can help facilitate improved access to healthcare for residents in these Greenlandic settlements. Regarding challenges in using telemedicine in Greenland, the geographical and cultural context hinders accessibility to the Greenlandic healthcare system, and telemedicine equipment is not sufficiently mobile.CONCLUSION: Greenlandic citizens are positive toward telemedicine and regard telemedicine as a facilitator for improved access for healthcare in the Greenlandic settlements. We have identified challenges, such as geographical and cultural context, that hinder accessibility to the Greenlandic healthcare system.

Objectives. The purpose of this study is to examine the association between Internet use among retired older adults in the United States and changes in a commonly used predictor of depression (the CES-D).

The purpose of this paper is to examine the use of the Internet for health-related purposes and whether this usage is part of larger pattern of health-promoting behaviors, or health lifestyle. Pierre Bourdieu's concept of habitus provides the key theoretical concept that links health lifestyle and the digital inequality framework to explain how social conditions (i.e. social status and quality of Internet access) influence attitudes and behaviors. Path analysis is used to examine the relationship between key endogenous variables on attitudes, health behavior, health status, and online health-related activities, while controlling for demographics and other factors. Data comes from the National Cancer Institute's 2007 Health Information National Trends Survey. The results demonstrate that online health behaviors can be usefully conceptualized as elements of health lifestyle. The combination of health lifestyle and digital inequality provides a broader theoretical framework that highlights the importance of ...

The findings regarding the impact of Internet use on well-being are mixed and studies are often criticized due to small samples and lack of consistency in measurement. Fewer studies have examined this issue among older adults. The purpose of this study is to examine the relationship between Internet use and depression among retired Americans age 50years or older. Using data from the Health and Retirement Survey, the study estimates the relationship between Internet use and depression through combined use of regression and propensity score methodologies. All empirical methods indicate a positive contribution of Internet use to mental well-being of retired older adults (>=50years), reducing depression categorization by approximately 20-28%.

Objective. Few social scientists have examined how Internet usage, including using the Internet for health purposes, may affect mental health. This study assesses whether the type or amount of online health activities and the timing of Internet use are associated with psychological distress. Methods. We use data from the National Cancer Institute's 2005 Health Information National Trends Survey. Results. When we compare Internet users to non‐Internet users, using the Internet and using the Internet for health purposes are negatively associated with distress. However, among Internet users, the number of online health activities is positively associated with distress. Greater distress is also associated with using the Internet on weekdays and looking online for information on sun protection. Conclusions. Internet usage is not necessarily positively associated with psychological distress. The effects depend on the type, amount, and timing of Internet usage.

Literature has shown that people living in rural areas are less likely to have access to the Internet for demographic and technological reasons; however, less information is available regarding rural—urban differences in online health-information seeking. Data from the National Cancer Institute’s nationally representative 2005 Health Information National Trends Survey ( N = 5,586) are used to examine these relationships. Logistic regression results show that those in rural areas use the Internet less than those who live in urban areas. Among individuals who have used the Internet, those in rural areas are less likely to use the Internet for health purposes. The persistence of a digital divide between rural and urban residents in online health searching is attributable to factors such as educational level, income, and diffusion of broadband. The article discusses the impact of these differences.

Research investigating the impacts of computer and Internet use is increasing; however, few sociologists explore how this use may impact on mental health outcomes. The authors use data from the 2004 General Social Survey to examine the relationship among gender, computer and Internet use for health purposes and mental health. Their findings are mixed in that computer and Internet use are both positively and negatively related to mental health. They find evidence that there may be a selection bias occurring in which those with the greatest well-being problems are the ones searching online for health information. When computer and the Internet use variables were included in the models, the effect of gender on likelihood of experiencing poor mental health was attenuated, which suggests that particular types of Internet use may mediate gender disparities in mental health.

Purpose Information and communication technology (ICT) usage is pervasive among present day youth, with about 95% of youth ages 12–17 years reporting use of the Internet. Due to the proliferation of ICT use among this generation, it is important to understand the impacts of ICT usage on well-being. The goal of this study was to determine the impact of ICT usage on psychological well-being among a sample of urban, predominately African American youth. Methodology/approach Paper and pencil surveys were administered to fourth and fifth grade students enrolled in 27 elementary schools in the southeastern United States. Relationships between hours using various types of ICTs and the frequency of Internet activities on depression, hopelessness, self-esteem, and belonging were examined using Ordinary Least Squares (OLS) regression. Findings Results indicate that ICT usage has both positive and negative implications for psychological well-being, depending upon the type of ICT use and outcome being examined. Social Implications The proliferation of ICT usage among present day youth may actually lessen its impact on psychological well-being. Since the amount of ICT usage does not seem to influence psychological well-being, future research should examine the impact of ICT content on psychological well-being.

Purpose Since 2000, there has been a dramatic increase in the number of individuals using the Internet, including for health purposes. Internet usage has increased from 46% of adults in 2000 to 79% in 2010. The purpose of this chapter is to examine changes in one type of Internet usage: online health searching. We examine the impact of traditional digital inequality factors on online health searching, and whether these patterns have changed over time. Methodology Using data from five surveys ranging from 2002 to 2010 (n = 5,967 for all five surveys combined), we examine changing patterns of online health searching over the past decade. Findings Effects vary by inequality factor and time period examined. Despite the diffusion of the Internet, most of these gaps persist, and even strengthen, over time. Gender, age, and education gaps persist over time and appear to be increasing. An exception to this is the importance of broadband connection. Research limitations Since these data were collected, the use of mobile devices to access the Internet has increased. Research is needed on types of access and devices used for online health activities. Implications Larger scale inequalities play important roles in online health searching. Providing access and skills in evaluating online health information is needed for older and less educated groups. The results of this study have implications for the de-professionalization of medical knowledge. Originality This is the first study to examine digital inequality factors in online health information seeking over the breadth of this time period.

BackgroundTo reduce the cost of health care while increasing efficiency and quality, health systems are seeking innovative means to engage and empower patients. Improved use of information technology and electronic health record (EHR) infrastructure is essential, and required for “meaningful use” as mandated by the federal government. Providing personalized health information using tablets at the point of care could enhance the clinical experience and enable efficient collection of patient reported outcome measures to guide clinical decision making. ObjectiveThe aim of this study is to explore patient and provider attitudes and interest in a proposed clinic-based tablet system for personal health information exchange. To provide a context to understand patients’ use of tablets during their clinic visit, we also examine patients’ current activities and time spent in the waiting room, and their use of health information resources. MethodsSurveys were administered to 84 patients in the waiting room of a community health center affiliated with Massachusetts General Hospital (MGH) in Boston, MA. This survey included a vignette and illustration describing a proposed tablet-based system in which the patient, upon sign in at the clinic, receives a tablet loaded with personalized information tailored to their specific medical conditions and preferences. Patients were queried about their interest in such a system in comparison to traditional forms of patient education as well as their current health information seeking behaviors and activities and time spent in the waiting room. Interviews with five MGH-affiliated health care providers were conducted to assess their opinions regarding the proposed tablet system. ResultsThe majority (>60%) of patients were “very” or “extremely” interested in the proposed tablet system and thought it would improve their knowledge about their medical condition (60%), assist them in making healthy choices (57%), and help them to feel more comfortable talking with their provider (55%). Patients thought the system would be more motivating, informative, and engaging than traditional printed health education materials. The tablet system was not considered more effective than face-to-face interaction with providers, though 44% thought it would improve their relationship with their physician. Overall, 91% of respondents were willing to learn how to use a tablet and 75% reported being “very” or “extremely” confident they could use one. Four of the five providers believed that the proposed tablet system would improve clinical workflow and patient education. Patients and providers were concerned about privacy and security of data collected using the tablets. ConclusionsBoth patients and providers were highly amenable to integrating tablets into the clinical experience, and tablets may be useful in improving patients’ health knowledge, the collection of patient reported outcome measures, and improved patient-provider communication. Further research into operationalizing such systems and their validation is necessary before integration into standard clinical practice.

The purpose of this study is to examine the association between Internet use among retired older adults in the United States and changes in a commonly used predictor of depression (the CES-D).Analyzing data from four waves (2002-2008) of the Health and Retirement Survey, we assess whether an available and commonly used index of a depression state was affected by prior values of the index and Internet use. The sample includes 3,075 respondents observed over 4 waves of data, yielding a total of 12,300 observations. We analyzed the effect on depression of Internet use and past depression in a full sample and a matched sample. We also conducted informal tests for confounders. Finally, we tested a basic mediation model to determine whether Internet use affected depression through its relationship with loneliness and social isolation.Across methods, we found a positive contribution of Internet use to mental well-being of retired older adults in the United States, where Internet use reduced the probability of a depression state by one third. We found no evidence of confounding. Some evidence of mediation was found.Our dynamic probit model indicates that for retired older adults in the United States, Internet use was found to reduce the probability of a depressed state by about 33%. Number of people in the household partially mediates this relationship, with the reduction in depression largest for people living alone. This provides some evidence that the mechanism linking Internet use to depression is the remediation of social isolation and loneliness. Encouraging older adults to use the Internet may help decrease isolation and depression.

Background: Heart failure (HF) is a chronic condition affecting nearly 5.7 million Americans and is a leading cause of morbidity and mortality. With an aging population, the cost associated with managing HF is expected to more than double from US $31 billion in 2012 to US $70 billion by 2030. Readmission rates for HF patients are high—25% are readmitted at 30 days and nearly 50% at 6 months. Low medication adherence contributes to poor HF management and higher readmission rates. Remote telehealth monitoring programs aimed at improved medication management and adherence may improve HF management and reduce readmissions. Objective: The primary goal of this randomized controlled pilot study is to compare the MedSentry remote medication monitoring system versus usual care in older HF adult patients who recently completed a HF telemonitoring program. We hypothesized that remote medication monitoring would be associated with fewer unplanned hospitalizations and emergency department (ED) visits, increased medication adherence, and improved health-related quality of life (HRQoL) compared to usual care. Methods: Participants were randomized to usual care or use of the remote medication monitoring system for 90 days. Twenty-nine participants were enrolled and the final analytic sample consisted of 25 participants. Participants completed questionnaires at enrollment and closeout to gather data on medication adherence, health status, and HRQoL. Electronic medical records were reviewed for data on baseline classification of heart function and the number of unplanned hospitalizations and ED visits during the study period. Results: Use of the medication monitoring system was associated with an 80% reduction in the risk of all-cause hospitalization and a significant decrease in the number of all-cause hospitalization length of stay in the intervention arm compared to usual care. Objective device data indicated high adherence rates (95%-99%) among intervention group participants despite finding no significant difference in self-reported adherence between study arms. The intervention group had poorer heart function and HRQoL at baseline, and HRQoL declined significantly in the intervention group compared to controls. Conclusions: The MedSentry medication monitoring system is a promising technology that merits continued development and evaluation. The MedSentry medication monitoring system may be useful both as a standalone system for patients with complex medication regimens or used to complement existing HF telemonitoring interventions. We found significant reductions in risk of all-cause hospitalization and the number of all-cause length of stay in the intervention group compared to controls. Although HRQoL deteriorated significantly in the intervention group, this may have been due to the poorer HF-functioning at baseline in the intervention group compared to controls. Telehealth medication adherence technologies, such as the MedSentry medication monitoring system, are a promising method to improve patient self-management,the quality of patient care, and reduce health care utilization and expenditure for patients with HF and other chronic diseases that require complex medication regimens. Trial Registration: ClinicalTrials.gov NCT01814696; https://clinicaltrials.gov/ct2/show/study/NCT01814696 (Archived by WebCite® at http://www.webcitation.org/6giqAVhno) [J Med Internet Res 2016;18(5):e91]

Objective. Few social scientists have examined how Internet usage, including using the Internet for health purposes, may affect mental health. This study assesses whether the type or amount of online health activities and the timing of Internet use are associated with psychological distress.Methods. We use data from the National Cancer Institute's 2005 Health Information National Trends Survey.Results. When we compare Internet users to non-Internet users, using the Internet and using the Internet for health purposes are negatively associated with distress. However, among Internet users, the number of online health activities is positively associated with distress. Greater distress is also associated with using the Internet on weekdays and looking online for information on sun protection.Conclusions. Internet usage is not necessarily positively associated with psychological distress. The effects depend on the type, amount, and timing of Internet usage.

BackgroundCurrently, the increasing interest in telehealth and significant technological breakthroughs of the past decade create favorable conditions for the widespread adoption of telehealth services. Therefore, expectations are high that telehealth can help alleviate prevailing challenges in health care delivery. However, in order to translate current research to policy and facilitate adoption by patients and health care providers, there is need for compelling evidence of the effectiveness of telehealth interventions. Such evidence is gathered from rigorously designed research studies, which may not always be practical in many real-world settings. ObjectiveOur aim was to summarize current telehealth evaluation strategies and challenges and to outline practical approaches to conduct evaluation in real-world settings using one of our previously reported telehealth initiatives, the Diabetes Connect program, as a case study. MethodsWe reviewed commonly used current evaluation frameworks and strategies, as well as best practices based on successful evaluative efforts to date to address commonly encountered challenges in telehealth evaluation. These challenges in telehealth evaluation and commonly used frameworks are described relevant to the evaluation of Diabetes Connect, a 12-month Web-based blood glucose monitoring program. ResultsDesigners of telehealth evaluation frameworks must give careful consideration to the elements of planning, implementation, and impact assessment of interventions. Evaluating performance at each of these phases is critical to the overall success of an intervention. Although impact assessment occurs at the end of a program, our review shows that it should begin at the point of problem definition. Critical to the success of an evaluative strategy is early planning that involves all stakeholders to identify the overall goals of the program and key measures of success at each phase of the program life cycle. This strategy should enable selection of an appropriate evaluation strategy and measures to aid in the ongoing development and implementation of telehealth and provide better evidence of program impact. ConclusionsWe recommend a pragmatic, multi-method, multi-phase approach to telehealth evaluation that is flexible and can be adapted to the characteristics and challenges unique to each telehealth program.