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Using Information and Communication Technologies to Close the Health Disparities Gap
Nicole R. Keith, PhD, Member of the Ethnic Minority and Multicultural Health SIG
Physical activity (PA) is an effective tool in improving health. Yet few Americans, and even fewer minority and low-income individuals, meet the recommended guideline of obtaining 150 minutes of PA each week. Lack of PA participation at least partially explains health disparities in minority and disadvantaged populations. Participation barriers are multilevel. Environmental barriers include poor or no sidewalks or walking trails, lack of green space, traffic, and fear of crime. Resource barriers to PA participation include time, cost, childcare, and travel limitations. PA participation may be intrinsically impeded by the participant's lack of motivation, knowledge and/or social support. Recognizing and eliminating PA barriers in the most resource-limited communities will likely aid in improving PA participation levels for all Americans.
Behavioral medicine research has identified the need for PA programs that provide frequent contact to achieve regular and sustained participation. Group-based PA interventions have been effective in helping participants achieve and maintain recommended PA levels. Group programs are limited because they generally require individuals to overcome participation barriers. Thus, group-based PA programs have not yet met their full public health impact potential. Behavioral scientists have tested several technologies to overcome barriers and increase participation in PA programs. In the last two decades technologies included the use of videos, DVDs, and cable television programs. More recently, PA interventions have been delivered through Web-based technologies. Current interventions intend to capitalize on early technologies while using more advanced information and communication tools (i.e. internet, automated calling, or video-conference) to deliver social support, tailor messages, and modify activities based on the individual's response to and level of participation in technology-delivered activities.
Technologically-based interventions delivered to individual homes eliminate most barriers to PA participation. Travel and time are addressed as participants only need to be at home to receive the intervention and can elect when to participate. Children can be monitored by the participant while he/she receives counseling or direction. If there is frequent interaction among the participants and counselor, and the program is regularly accessible, the participant's motivation, knowledge, and perception of social support availability may be improved. However, the cost barrier might not be addressed through the use of technology. The extent to which personal costs could impede individuals in disadvantaged situations from participating in technology-based programs must be explored. Also worthy of investigation is whether individuals with low-levels of education and resources would accept a technology-based PA intervention.
Much of the current research focusing on technologies for PA interventions targets a well-educated, economically advantaged population. Few technology-based interventions target lower income or minority populations. Failure to recruit these populations may be due to perceived issues with internet access. However, Bensley et al. (2006) successfully conducted a Web-based evaluation of 39,541 low-income women in the Special Supplement Nutrition Program for Women, Infants and Children (WIC), who completed web-based interventions in seven states. Campbell (2009) evaluated internet use among minority seniors living in low-income residential buildings and found with training, the Web is a viable health information tool. Although few in number, there are other studies supporting the tenet that Web-based programs can be used to promote PA among vulnerable populations. More research is needed. As behavioral scientists make progress in improving PA interventions through technology use, it is important that minorities and the disadvantaged are recruited and their needs are considered in order to avoid further widening of the health disparities gap.