The need for feminist intersectionality in digital health
نویسندگان
چکیده
Digital health, including the use of mobile health apps, telemedicine, and data analytics to improve systems, has surged during COVID-19 pandemic. The social economic fallout from further exacerbated gender inequities, through increased domestic violence against women, soaring unemployment rates in unpaid familial care taken up by women—all factors that can worsen women's health. bolster equity access care, empowerment one's own data, reduced burden work. Yet, digital is rarely designed a perspective. In this Viewpoint, we show because lower exclusion app design, imbalance leadership, harmful stereotypes, disadvantaging women—especially women with racial or ethnic minority backgrounds. Tackling health's inequities more crucial than ever. We explain our feminist intersectionality framework tackle provide recommendations for future research. Telemedicine boomed pandemic, largest increases (>109%) occuring between March, 2020, April 7, behavioural appointments (eg, psychotherapy, psychiatry) remote consultations chronic illnesses.1Uscher-Pines L Thompson J Taylor P et al.where virtual was already reality: experiences nationwide telehealth service provider pandemic.J Med Internet Res. 2020; 22e22727Crossref PubMed Scopus (3) Google Scholar A scoping review identified almost 250 public applications—30% using artificial intelligence detect infections, develop novel treatments, continue regular care.2Gunasekeran DV Tseng RMWW Tham Y-C Wong TY Applications responses COVID-19: systematic intelligence, related technologies.NPJ Digit Med. 2021; 4: 40Crossref (26) Finally, venture funding sector 66% 2020 compared 2019.3Roth M ignites investment activity.https://www.healthleadersmedia.com/innovation/covid-19-ignites-digital-health-investment-activityDate: Jan 11, 2021Date accessed: March 1, 2021Google UN argues policy report reallocation priorities sexual reproductive services, adversely affects health.4UNPolicy brief: impact on women.https://www.unwomen.org/-/media/headquarters/attachments/sections/library/publications/2020/policy-brief-the-impact-of-COVID-19-on-women-en.pdfDate: 9, 2020Date February 20, reduce face-to-face barriers endure men: childcare, household chores, inadequate finances, time.5Power K pandemic families.Sustain Sci, Pract Policy. 16: 67-73Crossref (236) empower their up-to-date information. relieve high workload status health-care workers (who are mostly female [86%] low-income colour [51%]),6Scales Altman Campbell S It's time care: detailed profile America's direct workforce.http://phinational.org/resource/its-time-to-care-a-detailed-profile-of-americas-direct-care-workforce/Date: apps monitoring patients at home, coordinating supporting older relatives. before applications have been perspective focus fairness distribution different needs genders.7Crawford Serhal E innovation curve cannot reinforce gradient health.J 22e19361Crossref (83) why treating unfairly, especially examples stereotypes. high-income countries, solutions still niche area, marginalised groups such as minorities low-incomes under-represented.8Sarkar U Gourley GI Lyles CR al.Usability commercially available diverse patients.J Gen Intern 2016; 31: 1417-1426Crossref (123) Overall, tackling how it benefit illustrate issues three levels: users, tools, leadership. offer bias intersectional framework. Intersectional feminism theoretical helps examine intersects other identities race ethnicity, socioeconomic status, sexuality, disability) result marginalisation, disadvantage, poorer outcomes.9Couto MT Oliveira Ed Separavich MAA Luiz OdC field health: narrative theoretical-methodological literature.Salud Colect. 2019; 15e1994Crossref (7) one theory within family approaches, which originated theories Black, Indigenous, queer feminism.10Sharma Applying medical education.Lancet. 393: 570-578Summary Full Text PDF (28) Intersectionality analyses highlight important differences population based gender, accessing receiving services.11Kapilashrami Hankivsky O matters global health.Lancet. 2018; 391: 2589-2591Summary Women often portrayed homogeneous group, yet multiple intersecting put some higher risk worse outcomes women. Owing spend fewer years good despite living longer men.12Gulati G Kelly BD Domestic pandemic: what role psychiatry?.Int Law Psychiatry. 71101594Crossref (32) even White USA, incidence diseases cervical cancer,13National Center Health StatisticsCrude percentages cancer aged 18 over, United States, 2015–2018. 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Although inequity problem, analysis countries. starting point conversation about need addressed eliminate disparities. countries men tools.21Rising CJ Jensen RE Moser RP Oh Characterizing US patterns behavioral tracking: Cancer Institute's Information Trends Survey data.J 22e16299Crossref (9) However, majority tools do address priorities.22Nwolise CH Carey N Shawe Preconception education diabetes: conventional interventions.J 18: e291Crossref (13) Scholar, 23Lupton Maslen How technologies qualitative interview study.J 21e11481Crossref (31) According Rock Health,24Sandhu Gambon Stotz C Zweig Evans B Femtech expansive—it's start such.https://rockhealth.com/femtech-is-expansive-its-time-to-start-treating-it-as-such/Date: Aug 3, 2020Google just 3% commercial capitalist since 2011 focused Furthermore, gaps provision persist counterparts. For example, Black participate pregnancy services often,25Nijagal Patel al.Using human centered design identify opportunities reducing perinatal care.BMC Serv (published online 13, 2021.) (preprint).https://doi.org/10.21203/rs.3.rs-138912/v1Crossref (1) mortality rate infants non-Hispanic remaining highest USA.26Ely DM Driscoll AK Infant period linked birth/infant death file.Natl Vital Stat 69: 1-18Google Hispanic Latina under-represented interventions physical activity,27Joseph Keller Adams MA Ainsworth BE Print versus culturally-relevant Facebook text message delivered intervention promote activity African American women: randomized pilot trial.BMC 15: 30Crossref (81) although least physically active women.28Blackwell DL Villarroel Summary statistics: Survey, 2017—table A-4a. 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Thus, endanger breaches others. Many gendered language design. mixed-method symbols, colours, language, found most were neutral, had stereotypically designs, pink hearts, flowers.36Foxton Chateau norms reconstructed store ecologies visual interfaces?. University Amsterdam, 1-9Google Fitness boasted strength muscles, whereas thinness femininity. 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UK Service's Babylon app, released 2017, probability self-reported symptoms. advised course contact doctor, visit emergency room, no action. smoker 59 symptoms heart attack (ie, chest pain, shortness breath, anxiety) received panic attack, same background informed possibility attack.45Trendall concerns raised GP app.https://www.publictechnology.net/articles/features/gender-bias-concerns-raised-over-gp-appDate: Sept 2019Date October affected cardiovascular disease earlier awareness leading cause death.46Kalinowski JY Spruill TM Why black disease?.Circulation. 139: 1003-1004Crossref (8) Algorithm terms ethnicity reported. algorithm recommended needed basis costs, erroneously assigned requirements being considerably sicker thus needing extra care.47Obermeyer Z Vogeli Mullainathan Dissecting manage populations.Science. 366: 447-453Crossref (621) backgrounds decades,48Feldman Ammar W Lo Trepman van Zuylen Etzioni Quantifying scale automated extraction.JAMA Netw 2e196700Crossref (35) reflect Individuals non-binary categories did searches electronic databases search engines gauge extent individuals developed, non-conforming, genderqueer, genderfluid, transgender, spectrum), medicine, research), eHealth, mHealth, intervention, app). line studies,49Vandelanotte Müller AM Short CE al.Past, present, eHealth mHealth dietary behaviors.J Nutr Behav. 48 (28.e211): 219Summary (189) unable many articles all domains. absence populations ineffective groups, data. 50% workforce female, gap leadership persists, wider fields. 12·2% funds held 10% chief executive officer positions.50Rock HealthDiversity annual report.https://rockhealth.com/reports/diversity-in-digital-health-2020-annual-report/Date: December 2019 European survey51HIMSS EuropeWomen IT survey 2019.https://www.himss.eu/communities/women-health-it-communityDate: employed companies paid excluded making men. struggle workloads receive recognition public-speaking opportunities), peers.51HIMSS greater under-representation. led venture-backed those pronounced women.52Denend McCutcheon Regan Sainz Yock Azagury Analysis perceptions technology: call action.Ann Biomed Eng. 48: 1573-1586Crossref rise roles, face unequal treatment. Men differ opinions workforce. believe tech equal, contrast, shut out
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ژورنال
عنوان ژورنال: The Lancet Digital Health
سال: 2021
ISSN: ['2589-7500']
DOI: https://doi.org/10.1016/s2589-7500(21)00118-7