Advanced digital health enhancing equity in Thailand
Introduction
Digital health has become a cornerstone of contemporary healthcare systems, offering transformative solutions to address disparities in access and quality. In Thailand, a nation renowned for its progressive healthcare initiatives, integrating digital health technologies has played a pivotal role in promoting equity. Health equity involves diminishing or eradicating inequalities in health.1 Embedded within the numerous descriptions of health equity are fundamental human rights, societal inclusion, fair distribution of resources, and a concerted endeavour to address systemic violence and institutional bias.
Availability of digital health
Digital health, through its various components, such as telemedicine, mobile health (mHealth), and electronic health records (EHRs), has the potential to significantly resolve equity issues in healthcare by enhancing access and outreach, especially for under-served populations. A contemporary example of digital health enhancing access and outreach was demonstrated during the COVID-19 pandemic. Telemedicine and mHealth applications have been instrumental in providing healthcare services and information to people in lockdowns and remote areas. The pandemic accelerated the adoption of telehealth globally, including in Thailand, where telemedicine helped bridge the gap in healthcare access, ensuring that individuals, even in rural or isolated regions, could receive medical advice and care without the need for physical travel to healthcare facilities.2
Impact of digital health on health equity
Digital health has the potential to significantly reduce health disparities and promote equity in healthcare delivery, ultimately leading to better health outcomes for all in four ways.
1. Decreasing geographic barriers: In many countries, including Thailand, geographic barriers can limit access to healthcare, particularly for those living in remote or rural areas. Digital health technologies, such as telemedicine enable healthcare professionals to reach patients regardless of location. Patients can consult with doctors, receive diagnoses and even get prescriptions without travelling long distances.
2. Increasing access to trusted healthcare information and tools: Digital health tools, including mHealth apps and SMS-based health education, can deliver crucial health information directly to individuals' mobile devices. This empowers individuals to make informed decisions about their health, regardless of their socioeconomic status or location.
3. Improving follow-up care: EHRs enhance follow-up care and care coordination. Patients' medical histories are readily accessible to healthcare providers, ensuring their health is managed consistently. This is particularly vital for patients with chronic conditions.
4. Expediting specialised care: Telehealth consultations can connect patients with specialists and primary healthcare providers, improving healthcare access for those who may not have immediate access to specialised care in their local areas. It ensures that healthcare expertise is distributed more equitably.3
Digital health in Thailand
Thailand is a country making significant strides in healthcare accessibility through innovative technologies. Three digital health initiatives can be described:
1. Telemedicine for assessable health care: Telemedicine has emerged as a powerful tool to bridge the healthcare divide, especially in remote and under-served areas. To address this problem, the Thai government, in collaboration with local healthcare providers and a telemedicine service provider, launched a telemedicine initiative in the village.
2. mHealth for preventive care: mHealth applications and messaging services are at the forefront of Thailand's efforts to promote preventive care. Through these digital tools, healthcare information, vaccination reminders and health education are delivered to individuals' mobile devices, empowering them to make proactive health decisions.
3. Health data analytics for informed decision-making: Thailand's healthcare system now leverages health data analytics for evidence-based decision-making. By analysing health data, authorities can identify health disparities, allocate resources more efficiently, and implement targeted interventions to reduce healthcare inequalities.4
Potential barriers
Nonetheless, despite rapid technological advancements in Thailand, there is a need for improvement in individual digital literacy. Based on a framework of digital health equity,5 the concept of health equity has expanded to encompass not just access to healthcare services, but also equitable access to digital resources and technologies. The digital determinants of health in intrapersonal play a pivotal role in shaping health equity, which includes digital literacy, digital access, digital self-efficacy and a person’s attitude towards its utilisation. These factors extend beyond conventional healthcare considerations and delve into the domains of technology, accessibility and digital proficiency.
Digital literacy is the foundation upon which digital health equity is built. It refers to the knowledge and skills required to navigate the digital world effectively. This encompasses understanding in how to access and evaluate online health information, communicate with healthcare providers through digital platforms, and use health-related apps and tools. Those who lack digital literacy may find themselves at a disadvantage when seeking health information or telehealth services, perpetuating disparities in healthcare outcomes. The other necessary component is digital access, a crucial determinant of digital health equity. Digital access remains a significant barrier, with under-served communities often having limited access to reliable internet and necessary devices. To achieve digital health equity, we must work to bridge this divide by expanding broadband access and ensuring all individuals have the necessary tools to engage in telehealth, access health information and manage their health digitally.
Digital self-efficacy, or the belief in one's ability to use digital technologies effectively, also plays a role in health equity. Individuals with higher digital self-efficacy are more likely to engage in proactive health behaviours, such as tracking their health metrics, participating in virtual consultations and using health-related apps. Empowering individuals to develop confidence in their digital skills can lead to better health outcomes for all.
A further consideration is attitudes towards digital health. Attitudes and perceptions about digital health tools and services significantly determine their adoption. Addressing misconceptions, concerns about privacy, and cultural beliefs surrounding digital health is essential for promoting equitable usage. By understanding and respecting diverse attitudes towards digital health, we can tailor interventions and services to meet the needs of people in various communities.
Recommendations
Achieving digital health equity is a multifaceted endeavour that requires attention to these digital determinants of health. It involves addressing disparities in digital literacy, promoting access to technology, fostering digital self-efficacy, respecting diverse attitudes and ensuring data privacy and security. By recognising and actively working to bridge these gaps, we can pave the way for a future where everyone has equal access to the benefits of digital health, ultimately improving health outcomes for all. As nations worldwide work toward enhancing healthcare access and outcomes, Thailand's experience is a compelling example of how innovation and commitment to improve intrapersonal digital literacy can drive transformative change.
Authors
Piyanut Xuto, Patraporn Bhatarasakook
The Thailand Centre for Evidence Health Care: A JBI Centre of Excellence, Chiang Mai, Muang, Thailand
References
1. Lawrence K. Digital health equity. In Linwood SL, editor. Digital Health. Exon Publications; 2022.
2. Thanakijsombat T, Bhatiasevi V, Suwanposri C. Public adoption of telehealth technology in Thailand. J Glob Bus Rev. 2022;24(1):14-33.
3. Haleem A, Javaid M, Singh RP, Suman R. Telemedicine for healthcare: capabilities, features, barriers, and applications. Sensors Int. 2021;2:100117.
4. World Health Organization. Data, analytics and delivery for impact in focus 2022: priorities for regions and countries [internet]. WHO; 2022. Available from: https://cdn.who.int/media/docs/default-source/world-health-data-platform/in-focus/infocus-2022.pdf?sfvrsn=d93f2d87_2&download=true
5. Richardson S, Lawrence K, Schoenthaler AM, Mann D. A framework for digital health equity. Dig Med. 2022;5:119.
Disclaimer
The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.
