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  • Yvonne Bonsu

Race, Gender, and Medicine: Telehealth in Gynecological Care and the Emergence ofDigital Navigators

The integration of telehealth into healthcare systems has emerged as a transformative tool,

particularly in addressing geographical and accessibility barriers for women in gynecological

care. Telehealth, defined as the utilization of information and telecommunications technology in

healthcare delivery, presents a promising avenue for expanding the reach of reproductive health

services, including family planning, contraceptive services, and safety decision aids for survivors

of intimate partner violence (IPV). However, as this technology is not yet widespread, various

challenges, including digital illiteracy and limited buy-in from clinicians, hinder its potential

impact. Telehealth also encompasses mobile health applications designed to gather patients’

health data, screening questionnaires, and educational materials. I must mention the inherent

sensitivity of health information when using telehealth programs, that could compromise patient

privacy and ruin trust in healthcare systems, leading to legal and ethical consequences. In this

blog I plan to bridge the importance of telehealth in gynecological care and the need for racial

equity in access to it once its use becomes more widespread. I offer a new role of digital

navigators in an effort to highlight that with new technological avenues, we must address current

inequities.



It is crucial to recognize the dual nature of telehealth: a revolutionary innovation for some, yet a

potential source of exacerbation for existing racial disparities. These disparities include but are

not limited to age, digital literacy, internet access, language barriers, and social determinants of

health such as transportation barriers, trauma, and food insecurity. Structural racism further

contributes to health disparities, posing a challenge to the goal of achieving equitable access to

healthcare through telehealth and other innovative technological advances.


Current gynecological research emphasizes our need to address the impact of telehealth on

women's reproductive health, especially when working to resolve racial disparities. I must note,

there is a significant gap in determining whether telehealth increases access to care and produces

superior outcomes compared to in-person care, particularly concerning reproductive health and

IPV in women. In a paper published by theAgency for Healthcare Research and Quality, it was

noted that as a result of telehealth visits, there were “changes in STI risk behaviors such as

having multiple sexual partners”. There were also “changes in protective behaviors such as

sexual abstinence, mutual monogamy, delayed initiation of intercourse, and use of condoms”.

Patients also reported feeling a deeper sense of empowerment with telehealth features. Thus,

telehealth has created positive outcomes in patient behavior, especially in gynecology.


There was a surge in technology use for clinical purposes during The COVID-19 pandemic, in

response to the demand for innovative solutions to bypass traditional roadblocks in patient care.

In an effort to confront the challenges hindering the widespread adoption of telehealth, a new,

promising avenue has emerged: Digital Navigators. Digital navigators are envisioned as crucial

mediators, equipped to assist both patients and clinicians in navigating and customizing

technology, training patients on cell phone use and apps, and ensuring data quality. However,

challenges such as the need for training and the associated barriers to clinician buy-in still

persist, especially in low and middle-income countries.


A study led by psychiatrist, Dr. Wisniewski, proposes a structured training program for Digital

Navigators, covering core smartphone skills, basic technology troubleshooting, app evaluation,

clinical terminology, data management, and patient engagement techniques. Such a program will

empower Digital Navigators to facilitate the integration of telehealth into gynecological care

seamlessly.


As we move forward, the development of policies that standardize personal and data privacy

must strike a balance between user-friendliness and security, ensuring equitable access by

incorporating multilingual platforms. Additionally, addressing deeply rooted mistrust within

communities of color towards the healthcare system is imperative. Historical traumas, such as

the exploitation of Henrietta Lacks, underscore the need for building trust and transparency in

the implementation of telehealth services before they can be widespread in the US.


In conclusion, while the use of telemedicine holds the promise of higher quality care, it is

essential to navigate carefully through the challenges posed by disparities in access and digital

literacy. We should strive towards a more inclusive and equitable future for telehealth in

gynecological care for all women.


Reviewed by: Reena Kagan

Graphic by: Alejandra Gonzalez-Acosta


References

Wisniewski, Hannah, et al. “The Role of Digital Navigators in Promoting Clinical Care and

Technology Integration into Practice.” Digital Biomarkers, U.S. National Library of Medicine,

26 Nov. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7768140/.


Telehealth for Women - Agency for Healthcare Research and Quality,

effectivehealthcare.ahrq.gov/sites/default/files/pdf/telehealth-women-protocol.pdf.


Senz, Kristen. “Racial Disparities in Telemedicine: A Research Roundup.” The Journalist’s

Resource, 20 July 2022, journalistsresource.org/home/racial-disparities-telemedicine/.

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