The Impact of Technology on Community Public and Mental Health

Daniel Letterman and Nicholas Fotinakes

California State University Monterey Bay

CST 462S: Race, Gender, & Class in the Digital World

Professor Brian Robertson

Fall 2022
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The Impact of Technology on Community Public and Mental Health

The rapid advancement of digital technologies over the last few decades has had a

profound impact on the landscape of modern public and mental health. With access to

health-related information on the internet, the development of telehealth, and improvements in

health technologies, public health is vastly different today than ever before. Social, racial, and

ethnic inequalities have always permeated healthcare, and health technologies have striven to

expand healthcare access to as many people as possible. The objective of this paper is to analyze

the areas in which digital technology has affected the overall public health within communities

and identify how these technologies have improved, failed to address, or exacerbated digital

disparities and health inequalities.

Literature Review

In general, researchers agree that technological advancements in relation to technology

have contributed to numerous societal and public health benefits such as public water treatment,

sewage management, vaccinations, access to information, and the use of digital technologies to

treat and prevent disease and mental illness. The widespread adoption of mobile devices,

wearable tech, and telehealth services makes access to healthcare easier for many. Still, social

disparities in health persist today, and technology, at least in some part, plays a role in this

continuing inequity. According to the CDC, people from differing racial and ethnic minority

groups still experience increased rates of disease and health conditions such as diabetes, obesity,

preterm birth, and cancer when compared to white Americans (What Is Health Equity?, 2022).

Researchers have posed numerous hypotheses about how technology has contributed to

the inequality present in modern public health for minority groups. Some researchers propose

that digital exclusion or a ‘digital divide’ has increased health inequalities due to issues of cost,
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accessibility, and acceptability by users (Spanakis et al., 2021). These researchers argue that

issues with income, age, and socioeconomic status affect differing community groups and their

ability to access the internet, digital technologies, and telehealth communications.

Other researchers suggest that it is not an issue of access to technology or the internet.

Statistics show that 86% of Americans on Medicaid own a smartphone, minority communities

have access to technology, and the issue of digital health inequality stems from inconsistent

tailoring of these digital health technologies in minority groups (Fitzpatrick et al., 2021).

Some research suggests that despite comparable levels of ownership of devices such as

smartphones, there are other limits in play that prevent underserved groups from fully utilizing

these tools for mental health treatment. Notably, limited data plans and lack of broadband at

home create a limiting barrier to freely utilizing video conferencing and other services. Minority

groups, especially in rural areas, tend to lack high-speed internet access, with nearly a quarter of

black people and over a third of Hispanic people lacking access (Ralston et al., 2019).

Also of note is language and literacy barriers. Thirty-two million American adults do not

meet basic literacy standards, with another four million unable to take a literacy test due to

language barriers, where such tests are administered in Spanish as well as English (Ralston et al.,

2019). Many technologies are text-driven and are limited to English, which poses difficulties to

use for groups unable to read English as well as those with poor literacy skills.

The issue appears to be multifaceted, with researchers holding differing views on what

are the main contributing factors to the modern technological health inequalities present today.

Further research may provide deeper insight into the validity and importance of certain

inequality causes and possible solutions.

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Research Question

What are the main technological-related factors that contribute to the disparities in

modern public and mental health between different socioeconomic groups, and what can be done

to address these inequalities to help close the gap of this technological digital divide?

Research Design

Professional Questions:

● How have modern technological advancements changed the landscape of public/mental

health within our communities?

● Why do you think disparities still exist between socioeconomic groups in regard to

public/mental health despite advancements in technology?

● How does technology affect your own work in public health in the modern world today?

● What do you think can be done to help lessen the inequality in health care in regard to

technology?

Community Questions:

● How have changes in technology over the years affected your relationship with public or

mental health services?

● What technological challenges have you faced regarding your ability to use or access

health care services? What technological benefits have you noticed?

● Why do you think certain socioeconomic groups still face healthcare disparity today

despite advancements in technology?

● What do you think can be done to improve any difficulties you see in regard to healthcare

and technology?
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The target audience for this research includes experienced public and mental health

professionals currently working in the field with a direct perspective on how technology relates

to health services within different socioeconomic groups. Additionally, the research will survey

the experiences of different community group members, including citizens over 65 years of age

and community members of different socioeconomic backgrounds. These participants will be

sampled from professionals within the partnered service organizations, students from CSUMB,

and San Luis Obispo county residents who have been contacted for permission. The interview

process will be conducted in person, using video conferencing software, and by email during the

week of October 2, 2022, through October 7, 2022. Research participants will be sent the

interview questions beforehand, and the interviewer will either record the interview or take notes

of the responses.

Service Organizations

The first service organization involved in this research is the County of San Luis Obispo

Public Health Department. According to the Health Agency’s home web page, “The Public

Health Department is a division within the Health Agency that promotes and protects the health

of our SLO county community” (Public Health - County of San Luis Obispo, 2022). The health

department deals with all aspects of public and mental health within San Luis Obispo County,

which includes a wide spectrum of socioeconomic groups, including college-aged students,

retired senior citizens, and migrant workers. The professionals at SLO County Public Health can

provide unique insight into how technology affects the different groups within the community.

The second service organization involved is Discovery Counseling Center, located in

Santa Clara County. The vision for the organization, according to their website, is “Always

remain compassionate when serving families in the community. Strive to help people discover
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tools to build personal wholeness, healthy families, and thriving communities” (About Discovery

Counseling Center, 2022). Discovery serves to work with individuals and the community to aid

in the mental and emotional well-being of its clients. They have various community programs,

such as The Bridge Project, Boldly Me Program, and Smart Kids Program, as well as providing

counseling services to local schools, allowing access to the services they provide to

underprivileged children in the community. During the Covid-19 pandemic, the organization

made a transition to the use of various technologies such as online telecommunication to

continue providing services to the community, which can provide insights into the benefits and

challenges that come with it.

In addition to the service organizations, research will be conducted using different

socioeconomic individuals, including residents of San Luis Obispo County and CSUMB

students. This will provide direct insight from community members within the target research

population of minority groups on how technology has impacted their relationship with public

health services.

Findings

The professional and community members interviewed were asked how digital

technology has affected the overall landscape or their relationship with public health. A common

theme shared amongst both professionals, and the community is that when there is access to

technology, it improves access to healthcare services. In Appendix B, the public health official

interviewed states that technology has made it easier to reach populations in rural areas as well as

non-native-speaking communities. The mental health professional noted in Appendix D had a

similar finding, stating that telehealth has made mental health services accessible to a wider

range of the population. The elderly community member and the non-native English-speaking
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student shared similar views, as seen in Appendix A and Appendix C, that over the years,

technology has made it easier for them to visit doctors and get prescriptions.

Both the professional and community interviewees were asked why they think social

disparities exist in public and mental health despite technological advancements. A common

theme from both the professional and community findings is that access to technology and the

internet greatly contribute to the digital divide. The counseling supervisor interviewed in

Appendix D noted that those in rural areas often have difficulty accessing the internet, which

affects their ability to utilize health services. In Appendix B, the public health professional noted

that disparities in public health regarding technology and access stem from overall historic

socioeconomic disparities such as oppression and familial wealth. Both the elderly community

member in Appendix C and the non-native student in Appendix A found that money was a

barrier to accessing technology needed to use health-related digital technologies.

Community members were questioned about any difficulties or benefits they have noticed

regarding health services and technology. Both the elderly member and non-native student

interviewed in Appendix A and Appendix C noted that their ability to understand or use certain

technologies hindered their access to healthcare services. Once they were comfortable using the

technology, their likelihood to use the services provided improved, and they felt they had greater

access to healthcare services.

The health professionals in Appendix B and Appendix D were asked how digital

technologies affected their work within the field. Both professionals found pros and cons

regarding technology's influence on public and mental health. The mental health expert found

that technology improved the ability and scope of patients to utilize health services when the

technology was available but also presented unique challenges, such as the lack of in-person
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signs helpful when providing mental health care. The public health professional noted that

technology played a vital role during the COVID pandemic, allowing them to quickly scale a

volunteer system for testing and vaccinating within the county. Without the use of modern

technology, this would not have been possible. The public health professional also noted some

potential negatives of the rapid increase and ease of information sharing today due to technology.

This has led to a large uptick in the spread of misinformation via information technology that has

had direct detrimental effects on achievements of public health such as vaccinations and fluoride

water treatments which have been large health benefits, especially for minority populations.

When asked about possible solutions to help close the digital divide, a theme shared

across all findings was improving access to the internet. Both health professionals in Appendix B

and Appendix D specifically stated providing free internet access as a possible solution to

improving digital disparities amongst socioeconomic groups. The non-native student in

Appendix A suggested that offering free courses to help teach people how to use advanced

digital technologies could help minority families more easily access health services as well.

Overall, these findings have addressed the research question posed about the causes of

digital disparities regarding technology and what can be done to close the digital divide.

Sampling members of both the community and professional side has given a wide breadth of

information regarding perspective on the core issues of digital health inequality and illuminated

common themes and clues about potential causes.

Conclusions

The findings conducted in this report covered both professional and different

socioeconomic community member experiences regarding digital disparities in healthcare

technology. Although the research question is complex and multifaceted, the information
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gathered has provided strong evidence illuminating a few main causes that currently contribute

to the digital divide regarding community health. Possible solutions to help close this divide

were also given, which will be addressed in the recommendations, providing enough data to

answer the research question stated in this paper fully.

Overall, both professionals and community members agreed that technology has led to

improvements in public health and healthcare. When there is access to and understanding of the

digital technology available, both community members found it easier to book appointments,

obtain medications, and track their healthcare. Advancements such as telehealth have made

patient access to mental and public health services easier than ever before. Professionals also

noted that technology has allowed them to provide better service to their communities when

funding is available, and access to technology exists.

Despite these benefits, socioeconomic disparities in public health still remain, and the

findings support that the main causes for this stem from historical inequalities that carry over

into the modern digital healthcare technologies and services we have today. The findings show

that the main issues contributing to this digital divide are a lack of access to technologies and the

education to understand and use these technologies due to these socioeconomic inequalities. It is

no question that technology can greatly improve the mental and public health of a community

when the technology is available, but social inequalities make access to and education about

these technologies difficult.

In the findings, both professionals noted that socioeconomic status affected a group’s

ability to access the technology necessary for modern health services. For instance, rural areas or

low-income populations often have difficulty obtaining internet access and wealth inequality

hinders the ability to purchase necessary technologies. Both community members shared
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personal experiences of money and limited access as barriers to using technology needed for

health services. Additionally, these members found that even when they obtained access, a lack

of understanding about how to use the technology also provided difficulties in obtaining health

services.

These conclusions reflect many issues and principles present in modern ethnic studies.

The inequalities that have affected ethnic minorities, lower economic groups, and elderly

populations in the past still permeate into these populations and their ability to access and use

digital technology that is now necessary for modern health services. Wealth is required to obtain

access to technology which is now a vital part of healthcare, and populations living in rural areas

and of lower economic status often cannot afford the technology or lack access to it altogether.

Inequality regarding access to education and low digital literacy increases the difficulty for these

groups to understand and use digital technology, which only widens the digital divide.

Recommendations

The information obtained in this report and the possible solutions suggested in the

research findings point to a few recommendations for future actions to help close the digital

divide regarding technology and health care. As the main causes contributing to this

health-related digital divide are digital education and access to technology, these

recommendations will point to improving access for all socioeconomic groups and providing

resources to understand and use these technologies.

One recommendation for improving equal access would be to deploy free municipal

wireless networks within cities and rural communities. Because the inability to afford or access

the internet is a major contributor to the disparities present in health-related digital technologies,

this would ensure that all communities would have internet access. Several cities worldwide have
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already developed a form of free public Wi-Fi, proving that the implementation is a practical

application in modern society. Having free city-wide internet access could drastically improve

access to health services for many disadvantaged community groups.

Another recommendation to help alleviate digital disparities would be to increase

resources and education to improve digital literacy for elderly and minority populations. Local

governments could provide advertisements about technological resources and educational

information on how to use them within their community. Elderly or minority community

members may not be aware of many modern technological health services available to them.

Providing alternative ways to spread knowledge of the benefits and existence of these

technologies can help increase awareness within these populations. Additionally, providing

access to free courses, seminars, or online instructional videos could improve these populations'

digital and health literacy, further closing the digital divide.

These recommendations can be implemented at local and federal government levels, as

well as within the private tech sector. Local governments can themselves push for the

development of public Wi-Fi infrastructures and the creation of digital education systems in their

county. Federally, laws can be implemented to require cities to have some form of internet access

available or require private tech companies to provide budget-friendly versions of their

technology and additional educational resources on their use.

While the disparities in digital technology and health are complex, actions to address the

main contributors of technological access and education can help close the digital divide and

lessen the inequalities present today. By providing easier access to the internet, accessible

technological devices, and educational resources to improve digital literacy, steps can be taken to

improve digital health services for all socioeconomic groups.

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References

About Discovery Counseling Center. (2022). Discovery Counseling Center.

https://www.mydiscoverycc.com/about

Fitzpatrick, L., Sikka, N., & Underwood, K. (2021, February 24). The Digital Divide in

Healthcare: It’s Not Just Access. HIMSS.

https://www.himss.org/resources/digital-divide-healthcare-its-not-just-access

Public Health - County of San Luis Obispo. (2022). County of San Luis Obispo.

https://www.slocounty.ca.gov/Departments/Health-Agency/Public-Health.aspx

Ralston, A. L., Andrews, A. R. III, & Hope, D. A. (2019). Fulfilling the promise of mental health

technology to reduce public health disparities: Review and research agenda. Clinical

Psychology: Science and Practice, 26(1), Article e12277.

https://doi.org/10.1111/cpsp.12277

Spanakis, P., Peckham, E., Mathers, A., Shiers, D., & Gilbody, S. (2021). The digital divide:

amplifying health inequalities for people with severe mental illness in the time of

COVID-19. The British Journal of Psychiatry, 219(4), 529–531.

https://doi.org/10.1192/bjp.2021.56

What is Health Equity? (2022). CDC. https://www.cdc.gov/healthequity/whatis/index.html

‌
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Appendix A

Interview With non-Native English Speaking College Student

This interview was conducted via email with a non-native English-speaking college student and

immigrant to the United States. This interviewee was chosen because of their insight into the

influence of digital technology on portions of the ethnic minority populations within

communities.

How have changes in technology over the years affected your relationship with

public or mental health services?

Before coming to the U.S and having access to all the new technology, I would have to

drive over 30 minutes to visit or make an appointment with the doctor. I lived in a small town,

and it was difficult to find clinics in the city and would ask for directions often. My family and I

would not visit the doctor often for the same reasons. Instead, I would rest in my room and hope

to get better soon. Becoming a U.S citizen and learning about technology in school, it became so

easy to visit the doctor when I was sick. I would use my cellphone to make appointments and get

directions on google maps. It became so easy to visit the doctor, dentist, and other services.

What technological challenges have you faced regarding your ability to use or access

healthcare services? What technological benefits have you noticed?

At first, it was very difficult to understand the system and protocols from the health care

services. Employees from clinics would tell me that I could access my information

online(insurance, payments) and that it was simple to register. At times I would get frustrated

since I didn't know I had to download an app or visit a specific website in the browser. Being an

immigrant and not knowing English at the time made it even more difficult since health care

services were only written in English only. Now that I understand these technologies, I visit the
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doctor more often, I am able to make bill payments to the clinics or insurance without having to

wait a long time on the phone.

Why do you think certain socioeconomic groups still face healthcare disparity today

despite advancements in technology?

This is because not everyone has the money, access, or resources to obtain that

technology. Or, if they do have access to technology, oftentimes, they are not taught to use

technology or its applications. Over the years, I have learned much more about these digital

technologies, and they have made my life much easier in many ways. However, my parents still

struggle when having to add a new contact, make an appointment, or input a direction on google

maps.

What do you think can be done to improve any difficulties you see in regard to

healthcare and technology?

I believe that if organizations offer free short courses on how to use technology, it will

become much easier for families to visit health services. This way, families or people that don't

know how to use technology will take advantage of the resources offered to them. It would be a

good idea to hand out simple flyers when visiting public services.
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Appendix B

Interview With County Public Health Official

This interview was conducted in person with a San Luis Obispo County Public Health Official,

and their answers were transcribed to text. This interviewee was chosen for their expertise in

Public Health and their insight into how technology may impact differing socioeconomic groups

within a community.

How have modern technological advancements changed the landscape of

public/mental health within our communities?

Well, Public Health has been slower to adopt technology for a few reasons. We have

HIPAA, which governs us, and that can make things such as digital technologies complicated to

innovate with and a sort of lag when it comes to incorporating new technologies. We also

struggle with funding because we rely on grants and different funding streams, so that can also

cause some lag time as well. As a whole, technology now makes it easier to reach

harder-to-reach populations such as those in rural areas or people who speak a different

language, who now have translation services that can help. Also, social media can play a role

because it can help us get the word out about different events or clinics we may have.

There is also a downside to these same technological advancements, as we witnessed

during the pandemic. Technology allows misinformation to spread very quickly and makes it

hard to counter this misinformation. The anti-vax movement started around the 1990s and

coincided with technology and the increase in information sharing. Vaccines are widely

considered one the biggest victories of public health, and the anti-vax movement is causing harm

to that. These types of misinformation movements also target other victories of public health,

such as fluoride in the water supply, which has greatly decreased cavities in children. These
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movements claim fluoride is a poison, whereas it actually helps many people who may not have

access to certain types of healthcare.

Why do you think disparities still exist between socioeconomic groups in regard to

public/mental health despite advancements in technology?

I would say health disparities are typically rooted in the bigger socioeconomic system,

not necessarily because it is a failure of public health. We work hard to reach everyone and that

we are equitable in our care, so if certain portions of the population require extra help getting

what they need, we put in the extra effort for them. These divides aren’t created by the public

health system, necessarily, but by other systems that are ingrained in American society. We have

populations that were historically oppressed, and while maybe now are less oppressed, those

impacts remain. When you have populations with a lot of family wealth and others who have not

had the same opportunities to develop that type of wealth, that can put people ahead, and you

will see disparities.

In Public Health, we can’t always solve all these disparities, but we can work extremely

hard that the services are still equitable and accessible to our whole community. This can include

having a phone line, even though we have online appointments, to help assist those who struggle

to do things online. We also try to ensure that our unhoused populations have access to the same

level of care, which can be difficult because they may not have a phone or internet. Equity is at

the forefront of our decisions in public health.

How does technology affect your own work in public health in the modern world

today?

During the COVID pandemic, we used technology quite a lot. I worked with volunteers,

and we had to develop a system to get hundreds of volunteers signed up a week for vaccination
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pods, as well as signups for testing. This was handled by two or three other people and me, so

technology played a major role in making that happen. I don’t think it would have been possible

to do this without technology. One of the barriers in Public Health is funding. There is software

available that can help us do what we need to do, but we can’t afford them. When we are

managing our grant, we only have a limited number of funds and often don’t have the option of

choosing something like software that can be helpful.

What do you think can be done to help lessen the inequality in health care in regard

to technology?

I think there are a lot of things that could help lessen it. If we are thinking big picture, on

a federal level, it could be something like free public Wi-Fi and ensuring that people have access

to the internet. I think that would be a big deal because today, everything is running off of

technology and the internet, so if you are unable to afford that, it is going to hinder what you can

do. I think that technology is great in public health for information sharing, so if one community

has an equity study or technique done, we can quickly get that shared with us to adopt these

techniques in our own community. So the use of technology to speed up information sharing is

helpful in that regard. Public Health is always going to be addressing equity and providing

equitable services to everyone. Still, I don’t think the problems are something solvable by Public

Health because they stem from other aspects of inequality in the community.
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Appendix C

Interview With An Elderly Community Member

This interview was conducted in person with a community member over 65 years of age with

their answers transcribed to text. This will provide data and insight into the perspective of elderly

community members and their experience with digital technology and its effect on public health.

How have changes in technology over the years affected your relationship with

public or mental health services?

I actually think it has improved and made it easier in some ways. One example is now

you can go online and talk to a doctor and get a prescription, and you don’t even have to go into

the office. It seems reasonable to me because typically, the doctor barely touches you anyway

and is just listening to your symptoms and diagnosing and prescribing, so it saves a lot of time

and effort.

What technological challenges have you faced regarding your ability to use or access

healthcare services? What technological benefits have you noticed?

I sometimes have issues using technology or applications for health services. My

insurance provides a card with $25 a month to be used for specific health-related items and uses

an app to check what items are eligible. Many times, the barcode or app doesn’t work properly,

and to call or figure things out with a real person is frustrating and time-consuming, and I often

cannot use it. When I have to book appointments, I typically find it easier just to call, but I

sometimes use the portal to see lab results or get refills.

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Why do you think certain socioeconomic groups still face healthcare disparity today

despite advancements in technology?

I think it is truly all about the money, if you have the money, you can get great healthcare.

That’s the problem with this country is not making it a priority for all people to have equal access

to healthcare no matter what they can pay. Nobody should go without decent healthcare.

What do you think can be done to improve any difficulties you see in regard to

healthcare and technology?

It’s a very difficult problem to change entire groups of people’s opinions on what the

masses should pay for. It is like children getting food in school, it should not be an issue, and I

don’t understand why some people would not want their taxes to go towards healthcare. Nobody

should suffer from a medical ailment because they can’t go to the doctor because they can’t

afford it or have access to the technology needed. I know someone who insisted on having her

baby at home because she did not have medical insurance because she did not have insurance

and it would cost too much money to go to the hospital. That’s not right, it should never be that

way.
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Appendix D

Interview With Mental Health Professional

This interview was conducted with a Counseling Supervisor at Discovery Counseling Center and

transcribed to text. This interviewee was chosen for their experience in the mental health field

and first-hand insight into how technology has impacted the practice regarding marginalized

groups.

How have modern technological advancements changed the landscape of

public/mental health within our communities?

Modern technology has made access to mental health care more accessible through all the

different modalities adding telehealth.

Why do you think disparities still exist between socioeconomic groups in regard to

public/mental health despite advancements in technology?

There are many barriers for accessing mental health care for lower SES (Socioeconomic

status) families. One factor is the stigma attached to getting and receiving help. Often lower SES

families do not know where to go to access care, and they don't want to ask that they are needing

support with their mental health due to negative judgment in society. Another factor has to do

with access to the internet. Many lower SES families live in rural areas where internet service is

spotty or obsolete.

How does technology affect your own work in public health in the modern world

today?

There are many pros and cons to technology in my own workplace environment. Some

pros are that therapists can access clients through telehealth from anywhere, not always needing

office space. Clients do not have to drive far if they are needing services and have internet. It has
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made offering mental health services easier through all the ways that it can be offered, but with

positive things, there are negatives, such as the space not being as personable. It is hard to read

body language over telehealth. I have had an experience where my client was crying, but I did

not know until she said she was sorry for crying. Another con is therapist no longer wanting to

come in the office to offer in-person services. Providing mental health care with kids is much

more challenging due to short attention spans. Confidentiality can sometimes be difficult due to

family members not having access to privacy.

What do you think can be done to help lessen the inequality in health care in regard

to technology?

Offering lower-income families free or low-cost internet to access telehealth. Offering

phone check-ins. Meeting the client where they are at by providing services at schools,

workplaces, or other locations.