Ovalle-Eliseo Stephanie, Mohammed Aisha, Islas Huerta Gabriela, Vossel Keith, Monserratt Lorena H, Díaz-Santos Mirella
Mary S Easton Center for Alzheimer's Research and Care, Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States.
J Med Internet Res. 2025 Aug 13;27:e67147. doi: 10.2196/67147.
BACKGROUND: The COVID-19 pandemic disrupted traditional health care delivery models, exacerbating disparities between those with and without ready access to digital technology. This digital divide poses a structural barrier to accessing equitable healthy aging resources and dementia care. Latino and Hispanic individuals, who constitute nearly half of Los Angeles County's population and face a projected tripling of Alzheimer disease and related dementia (ADRD) prevalence by 2040, are particularly impacted. OBJECTIVE: This paper aims to examine the barriers and facilitators affecting access to digital health education and resources for Alzheimer disease (AD) prevention and care management during the COVID-19 pandemic. This study focuses on the digital barriers possibly hindering Spanish-speaking Latino and Hispanic individuals in Los Angeles County from using online services offering critical AD prevention and care resources amid the COVID-19 pandemic. METHODS: We developed a conceptual model based on users' digital access or web literacy and language as barriers and facilitators impacting access to digital AD prevention and care resources. Between January 2022 and February 2022, we identified 15 websites of local organizations providing digital AD prevention services and resources in Los Angeles County during the pandemic. We applied our digital divide model to qualitatively evaluate the 15 websites. A post hoc analysis was conducted to reevaluate the 15 websites in 2025, and interrater reliability was evaluated using a Cohen κ analysis. RESULTS: Out of the 15 websites, 5 featured web navigation accessibility tools (4/15 in 2025), 4 provided content available in Spanish (6/15 in 2025), and 2 included resources for family dialogue about AD care and management (3/15 in 2025). One website showed cultural and linguistic responsiveness in its content (2/15 in 2025). Cohen κ analysis revealed substantial agreement for digital acceptability factors including Spanish language (κ=0.71), resources available in Spanish (κ=0.71), and family dialogue resources (κ=0.74). Agreement for web accessibility tools was moderate at (κ=0.53). We uncovered other unforeseen structural barriers to digital access, including email subscription requirements, English language-centered online forms, and the limited availability of Spanish-speaking staff. CONCLUSIONS: Our study highlights structural barriers hindering access to digital AD prevention and care resources tailored to the needs and values of Latino and Hispanic communities living in Los Angeles County. The findings emphasize the need to bridge the digital gap by incorporating user-friendly features and culturally and linguistically responsive elements in website design and implementation. This approach will move our field toward equitable access to digital ADRD prevention and care resources by mitigating structural barriers that sustain ADRD disparities in Latino and Hispanic communities.
背景:新冠疫情扰乱了传统的医疗服务模式,加剧了有和没有便捷数字技术人群之间的差距。这种数字鸿沟对获取公平的健康老龄化资源和痴呆症护理构成了结构性障碍。拉丁裔和西班牙裔人群尤其受到影响,他们占洛杉矶县人口的近一半,预计到2040年,阿尔茨海默病及相关痴呆症(ADRD)的患病率将增至三倍。 目的:本文旨在研究在新冠疫情期间,影响获取阿尔茨海默病(AD)预防和护理管理数字健康教育及资源的障碍和促进因素。本研究聚焦于在新冠疫情期间,可能阻碍洛杉矶县讲西班牙语的拉丁裔和西班牙裔人群使用提供关键AD预防和护理资源的在线服务的数字障碍。 方法:我们基于用户的数字接入或网络素养以及语言,开发了一个概念模型,将其作为影响获取数字AD预防和护理资源的障碍和促进因素。在2022年1月至2022年2月期间,我们确定了15个在疫情期间洛杉矶县提供数字AD预防服务和资源的当地组织的网站。我们应用数字鸿沟模型对这15个网站进行定性评估。在2025年进行了事后分析以重新评估这15个网站,并使用科恩κ分析评估评分者间信度。 结果:在这15个网站中,5个具有网页导航无障碍工具(2025年为4/15),4个提供西班牙语内容(2025年为6/15),2个包含关于AD护理和管理的家庭对话资源(2025年为3/15)。一个网站在其内容中表现出文化和语言响应能力(2025年为2/15)。科恩κ分析显示,在包括西班牙语(κ=0.71)、西班牙语可用资源(κ=0.71)和家庭对话资源(κ=0.74)等数字可接受性因素方面存在实质性一致。网页无障碍工具的一致性为中等(κ=0.53)。我们发现了其他意想不到的数字接入结构性障碍,包括电子邮件订阅要求、以英语为中心的在线表格以及讲西班牙语工作人员的可用性有限。 结论:我们的研究突出了阻碍获取针对洛杉矶县拉丁裔和西班牙裔社区需求和价值观的数字AD预防和护理资源的结构性障碍。研究结果强调需要通过在网站设计和实施中纳入用户友好功能以及文化和语言响应元素来弥合数字鸿沟。这种方法将推动我们的领域朝着公平获取数字ADRD预防和护理资源迈进,通过减轻维持拉丁裔和西班牙裔社区ADRD差距的结构性障碍。
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