Introduction

With the advent of the internet, the world appeared to reach a new level of connectivity; however, in what is termed the digital divide, a rift opened between those with access and those without. This disparity permeates numerous aspects of life, from social opportunities to education to economics and, most relevant to urologists, access to health care.¹ As health delivery has continued to evolve in parallel with the capabilities of digital technology, amplified by the COVID-19 pandemic and subsequent shift to increased telehealth, communities that lack broadband internet access have seen worse health outcomes.² As a result, several organizations recognize broadband connectivity and other aspects of digital technology utilization as determinants of health.^2,3

Urologists are major adopters of telehealth and should be aware of this public health inequity. The AUA 2022 Annual Census found that approximately 65% and 82% of urologists see patients virtually for initial and follow-up appointments, respectively.⁴ Recognizing its relevance to the field, the AUA convened the 2023 Quality Improvement Summit to discuss several key matters regarding telehealth, including barriers to integration and challenges posed by the digital divide.⁵ This article capitalizes on this month’s AUANews focus on diversity, equity, and inclusivity to underscore the necessity of addressing these digital disparities to ensure that these technological advancements in urological care benefit all segments of the population, regardless of their socioeconomic status or geographic location.

Understanding the Digital Divide

The digital divide (Figure) is defined as the gaps between individuals, communities, or larger populations of people who do or do not have access to critical technologies such as those used in health care.⁶ Within the US, the Federal Communications Commission estimates that 21 million to 42 million Americans lack high-speed internet access.⁷ Besides broadband access, factors like smartphone usage, affordability of technologies and services, and digital literacy contribute significantly to the digital divide.⁶ Significant overlap with preexisting disparities has been well documented along age, racial/ethnic, gender, and socioeconomic lines.⁶

The Importance of Broadband Connectivity in Urological Care

In the evolving landscape of health care, the digital revolution has introduced a paradigm shift in the delivery of medical services. The integration of digital tools and broadband connectivity into health care has given rise to telemedicine, electronic medical records, remote monitoring, and mobile health applications. These technologies are transformative and have the potential to be an equalizer for access. They have proven especially beneficial in the field of urology, where they enable remote consultations by reducing the need for physical visits and facilitate continuous monitoring of chronic conditions (ie, the proudP app for benign prostatic hyperplasia).^8,9 Broadband connectivity also enables access to up-to-date medical information, online patient support groups, and digital platforms for patient education, empowering patients with knowledge about their conditions and treatment options. However, the benefits of these advancements are not universally accessible.

Disparities in Broadband Access: A Barrier to Equitable Urological Care

Despite the clear benefits, the promise of digital health care has not been fully realized by all. Disparities in broadband access and other components of the digital divide pose a significant barrier to the equitable delivery of urological care. This divide is most pronounced in rural areas, in low-income communities, and among populations with limited technological literacy.¹ The lack of high-speed internet access in these communities means that patients face challenges in accessing telehealth services, online health resources, and digital communication tools for managing their health, which can then lead to delayed diagnoses, limited access to specialist care, and worse health outcomes.² Urologic conditions, especially those that already affect disadvantaged demographics, such as prostate cancer, urinary incontinence, and pelvic floor disorders, may not receive timely intervention and thereby exacerbate health disparities.

Strategies to Address the Digital Divide in Urological Care

To mitigate these disparities and promote equity in the delivery of urological care, a multifaceted approach is required. Key strategies include:

1. Expanding broadband infrastructure. Though more easily said than done, governments and private entities should collaborate to expand broadband infrastructure, especially in rural and underserved areas. This expansion is crucial for ensuring that telehealth services are accessible to all, enabling patients to receive timely and effective urological care.
2. Promoting digital literacy. Enhancing digital literacy among both health care providers and patients is essential for the effective adoption of telehealth services. Training programs and resources should be made available to equip individuals with the skills needed to navigate digital health care platforms. To that end, the 2023 AUA Quality Improvement Summit offered sessions on how to effectively incorporate telehealth into clinical practice and education on digital health technology utilization into residency training.
3. Ensuring affordability. The cost of broadband services and digital devices can be prohibitive for low-income families. Subsidies, affordable service plans, and programs that provide free or low-cost devices can help overcome financial barriers to access.
4. Adapting telehealth services. Telehealth services should be designed to be inclusive and accessible. This includes offering services in multiple languages, ensuring platforms are user friendly for individuals with disabilities, and providing options for patients without access to videoconferencing technology, such as telephone-based consultations. In fact, offering audio-only visits has been shown to be critical in bridging the digital divide to certain patient demographics, specifically those who are older, are American Indian and Alaska Native or Black/African American, need an interpreter, live in a rural area, or are on Medicaid.¹⁰
5. Advocating for policy change. Health care providers and organizations can play a pivotal role in advocating for policies that promote digital equity. This includes supporting legislation that funds broadband expansion, protects patient privacy in digital settings, and includes telehealth services in health care coverage (including appropriate reimbursement for audio-only visits). The recently held 2024 AUA Advocacy Summit (February 26 to 28) was carried out to do just this.

Conclusion

The digital revolution offers immense potential for enhancing the delivery of urological care, making services more accessible, efficient, and patient-centered. However, realizing this potential requires a concerted effort to bridge the digital divide and ensure equity in access to broadband connectivity. By implementing strategies to expand digital access, promote literacy, ensure affordability, adapt services for inclusivity, and advocate for supportive policies, the field of urology can move closer to achieving equitable health care for all. Incremental change is possible and valuable, and the AUA’s focus on promoting diversity, equity, and inclusion through addressing these issues is a commendable step toward this goal.