Health care delivery is undergoing an accelerated period of digital transformation, spurred in part by the COVID-19 pandemic and the use of “virtual-first” care delivery models such as telemedicine. Medical education has responded to this shift with calls for improved digital health training, but there is as yet no universal understanding of the needed competencies, domains, and best practices for teaching these skills. In this paper, we argue that a “digital determinants of health” (DDoH) framework for understanding the intersections of health outcomes, technology, and training is critical to the development of comprehensive digital health competencies in medical education. Much like current social determinants of health models, the DDoH framework can be integrated into undergraduate, graduate, and professional education to guide training interventions as well as competency development and evaluation. We provide possible approaches to integrating this framework into training programs and explore priorities for future research in digitally-competent medical education.
- Award ID(s):
- 2026614
- PAR ID:
- 10393673
- Date Published:
- Journal Name:
- JMIR Formative Research
- Volume:
- 6
- Issue:
- 4
- ISSN:
- 2561-326X
- Page Range / eLocation ID:
- e29535
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
More Like this
-
more » « less
Abstract -
more » « less
Generative pretrained transformer (GPT) tools have been thriving, as ignited by the remarkable success of OpenAI’s recent chatbot product. GPT technology offers countless opportunities to significantly improve or renovate current health care research and practice paradigms, especially digital health interventions and digital health–enabled clinical care, and a future of smarter digital health can thus be expected. In particular, GPT technology can be incorporated through various digital health platforms in homes and hospitals embedded with numerous sensors, wearables, and remote monitoring devices. In this viewpoint paper, we highlight recent research progress that depicts the future picture of a smarter digital health ecosystem through GPT-facilitated centralized communications, automated analytics, personalized health care, and instant decision-making.
-
more » « less
Abstract In this paper, I analyze the experiences of the world's largest all‐women community health workforce through the lens of liminality. Originally used to describe transition from one state to the other, the concept of liminality in the study of work and organizations can frame workers' experiences of being in‐between established structures and roles in varying degrees, times, and/or places. India's ASHAs, or Accredited Social Health Activists, are community women at the frontlines of the state's health care provisioning. But the state does not categorize them as workers or employees. ASHAs are considered volunteers. Instead of salaries, they are paid task‐based incentives. Based on 14 months of ethnographic fieldwork, including 80 interviews, I find that ASHAs' liminal occupational status as ‘paid volunteers’ produces conditions of chronic underpayment and control for them, further lowering their already low wages. This has implications for how we understand the gender wage gap. I argue that we need to consider not just how much women are paid, but how the payment is structured, and how that places marginalized women workers in relation to others in the workplace. Moving beyond whether liminality is a negative or positive experience, future research should delineate the conditions under which liminality is negative or positive.
-
Care workers are increasingly using digital technology in their daily lives, for monitoring, financial compensation, training, coordination, and more. State and corporate actors have invested significant resources to enable this digital shift, particularly during the COVID-19 pandemic. However, care work has remained chronically underpaid, and continues to rely on women from minoritized and marginalized backgrounds. Our paper examines how care workers carefully navigate digitization, precarity, and complex social relationships, in an attempt to care for their communities and each other. We analyze the emerging digital ecosystem for frontline health workers in India during the COVID-19 pandemic where these dynamics have been highly visible. Our research draws attention to four interconnected ways in which workers practiced care, by directing their efforts towards survival, resilience, advocacy, and/or resistance. We suggest these also as care orientations that can be adopted by researchers and practitioners, to critically reflect on and direct technology design towards enabling more caring futures, for (and with) workers and communities.more » « less
-
more » « less
Task shifting from trained clinicians to community health workers (CHWs) is a central, primary health care strategy advocated by global health policy planners in resource-poor settings where trained health professionals are scarce. The evidence base for the efficacy of these programs, however, is limited—in particular, research that identifies their potential unintended consequences. Based on sustained ethnographic study of CHWs working for AIDS projects in South Africa at the height of the country’s AIDS epidemic, this article identifies how structural and local factors produced unintended consequences for CHW programs. These consequences were (a) CHWs moonlighting for multiple organizations, (b) CHWs freelancing in communities without regulation, and (c) adverse patient outcomes resulting from uncoordinated care. These consequences stemmed from structural elements of a bureaucratically weak health system and from local grassroots dynamics that jeopardized long-term CHW program sustainability and eroded national health goals.
- Free Publicly Accessible Full Text
-
Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.2196/29535
