Bridging Socio-Economic Inequities in Healthcare Access: A Mobile Health Based Approach

Sajda Qureshi (University of Nebraska) presents an app-based solution for clinicians in Nebraska (USA) to offer socio-economic resources based on patient needs. The app has been piloted in a context of urban poverty where inequalities in access to healthcare increase the importance of readily accessible digital tools. This project gathers data on the distribution of healthcare facilities in Nebraska and identifies the inequalities (pattern, neighborhood effects) in this distribution. This project began in July 2019 and the observations contained here are from March to April 27 2020.

Background: Urban Poverty in South and North Omaha

As our observations revealed, in South Omaha Hispanic communities are close-knit and widely supportive of each other, cash-on-hand keeps institutional banks largely out of the community. Many supply chains are encapsulated among the businesses within the area. As we have observed, communities have built their own economic systems and internally adjust pricing that is manageable for members of the community, sometimes transactions for goods are conducted as favors. This key factor extends outward to the rest of the community economically, often leaving the remainder of funds as assistance to their families. Another accelerant in this region is the presence of industry. While these industrial complexes are owned external to the community, they provide a large source of economic support and income for new immigrants entering the area; immigrants often seek these types of manual labor jobs to support their family as they settle.

North Omaha, though similar in low economic development, is dissimilar in the community-supporting factors that South Omaha exhibited. The neighborhoods in this region were lacking evident forms of financial support; this was noted by directly observing the conditions of the infrastructure and of the community in general. The roads are not maintained to the extent that the rest of Omaha is, buildings have been repurposed many times over, and enterprises are sparse to non-existent. In the past, there were districts drawn based on ethnic prevalence, barring opportunity in pseudo-rational form by limiting city and state funding for infrastructure, schooling, and various community support programs. This districting additionally inhibited the residents from attaining financials from banks making the investment opportunities little to none. Today, the health status of North Omaha residents and lack of viable infrastructure are assumed byproducts of redlined districting, with the opportunity costs affecting generations of residents.

Intervention

In order to offer clinicians with the ability to address the socio-economic needs of their patients, a series of interventions comprising of technology and training solutions were carried out at the Free Student Clinic, which was started in 1997 to provide primary health care to multi-ethnic underserved populations in North and South Omaha. Patients who qualify for care at this clinic do not have health insurance and have, on average, an annual household income of 138% below the federal poverty level (Caucutt, 2019). The clinic is located in the middle of North and South Omaha, and it serves primarily the African American and Latino communities in the area.

Addressing the needs of marginalized communities requires interventions that are culturally sensitive while understanding the socio-economic causes of the patient’s malaise. As the clinic was pressed for funding, a free solution was implemented in March 2019 that fulfilled the need to offer a growing body of services. A mobile application with the community resource-related information was required so that the clinicians could find relevant socio-economic information for their patients.

Diagnosis of problems and needs assessments

While clinicians are able to address the symptoms that patients come in with, the longer term health of their patients need to be addressed through the social and economic causes of their illness. In order to assist patients in this way, clinicians need the relevant information on community resources. The researchers came up with an application with appropriate resources listed, and aims to benefit both the clinicians and patients. An app can save clinicians time as they can instantly look at their phones and get community-resources related information.

Mobile health (mHealth) technology has expanded access to healthcare in the researched context. Mobile health is much more than just accessing healthcare applications on a mobile phone as it can involve sensors and wireless networks in monitoring various conditions, mobile devices to access a variety of healthcare services, healthcare professionals to make decisions and provide emergency care, and support the elderly to manage their daily activities. The clinicians/physicians working in Free Student Led Clinics can get the right information at the right time about the right patient and in the right place quickly. In summary, the purpose of the app is to: 1) allow clinicians to look up appropriate community resources based on patient needs, 2) allow patients to leave the clinic with a plan for further support, and 3) allow clinics to more meaningfully help patients navigate bio-psycho-social barriers.

Development and Implementation of an IT solution           

To implement the free service, we put together a Google Sites application that fulfilled the community resources requirements. As the service is free, it solves the challenge of meeting financial requirements. Researchers and Clinicians sat down and walked through a prototype of the app. This is available as a website for clinicians who are at their desks as well as a mobile application that can be accessed through their phones.

Preliminary results

In order to achieve sustainability of the technology and training intervention, clinicians need to be able to use the app to support the socioeconomic needs of their patients. Following the initial implementation of the app, researchers visited the student-led free clinic on four separate occasions to observe how the app was being used by clinicians. Specifically, the researchers sought to analyse how the app was being used to address patient needs, how the app affected patient access to resources, and how the app could be improved to ensure the relevancy of its resource list and ensure that it was considered user friendly among clinicians.

As we were collecting additional data on socio-economic outcomes of the usage of these community resources by clinicians and their patients, COVID-19 started spreading through the communities. While the infection rate in Omaha is barely 2%, the unintended effects of the virus have been devastating. People who were barely surviving on minimum wage, are now experiencing homelessness, food insecurity and domestic violence as a result for the virus.

In order to address this situation, we retooled and updated our app so that individuals in need and or their caregivers can access needed resources. The updated version can be found at: https://sites.google.com/unomaha.edu/communityresource/home. While it is early to assess the specific socio-economic impact of this app, recent data suggests that among the effects of the COVID-19 shutdown have been increases in domestic violence, homelessness and food insecurity. In particular, there has been a sudden rise in the cost of prescription drugs. We expect that with the resources made available through this app, such hardship can at least to a certain extent be alleviated for those who are able to access the resources.

For more information contact: Prof. Sajda Qureshi, University of Nebraska, squreshi@unomaha.edu

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