Whether renewing prescriptions online, booking a doctor’s appointment or receiving test results in a health app, most people these days get at least some of their health needs met by using digital health platforms. While smartphones have, to some extent, narrowed the so-called digital divide (the gap between people with access to the internet and those without), not all digital health tools are created equal. And not everyone uses or has access to those tools in the same way.
This digital space is where health communication scientist Dr. Devlon N. Jackson, assistant research professor in SPH’s Department of Behavioral and Community Health, spends her time. She investigates inequalities and opportunities in how these now-ubiquitous digital health tools are used and accessed.
Recently Jackson published an article, co-authored with Dr. Cynthia Baur, in the Journal of Racial and Ethnic Health Disparities exploring digital health behaviors within Black communities. Now Jackson shares why we all should be paying more attention to research that delves into the nuances and complexities of human behavior beyond the traditional research focus on comparing large categories of people.
What drives your research?
I’m interested in centering community voices and getting beyond the monolithic, one-size-fits-all ways of considering groups of people and their digital health behavior. Exciting digital health innovations, like AI-assisted chatbots, are popping up all the time. My research asks: Are these tools truly reaching everyone and are they effective in improving health and healthy behavior in underserved or marginalized communities?
I study how digital health tools – such as apps, wearables, telehealth, AI-driven platforms, patient portals and electronic health records – support a person’s overall health. How does someone use or not use these tools to manage their health generally, support their mental health, inspire physical activity, healthy eating and getting important preventative screenings?
What is “within-group research” and why is it important to you and your work?
Researchers often study the digital health landscape through nationally representative samples that compare monolithic groups of people – for example, how people in a specific racial group use digital health tools like patient portals. We extrapolate from this – young adults are this, older people are that, Black adults do this, Hispanic adults do that. But this approach can limit our understanding and flatten important nuances that contribute to a person’s use of digital health tools. For example: Within the group Black adults, how does age factor in? How does a person's geographic location impact their digital access? What about language or immigration status? What about generational experiences of racism, xenophobia or homophobia in the health system?
Within-group research, where we look at more variables, gives us much more refined insight into how we can begin to address health disparities in the digital space. It better involves the different parts of us that inform certain beliefs and values and that contribute to our behavior in digital spaces — our race, gender, history, trauma, geography and much more.
To live healthily in the digital age, it is almost a necessity to be able to engage with digital platforms. And so examining how underserved and marginalized populations can or cannot access various digital health tools is crucial to health equity. And if you are seeking equity, you need to study within-group differences.
What did you find out about how diverse groups of Black people use digital health tools on their phones?
The digital divide still exists, especially in terms of reliance on smart phones: 85% of Black adults owned a smartphone, but only 71% had broadband access. For almost one in five Black adults, nearly 20%, a smartphone is the primary way in which they engage digital health tools, whereas just 13% of white adults and 11% of Asian adults are smartphone-dependent.
Our study out this week focuses on the digital health behavior of Black adults who use smartphones. Within this analysis we explored how certain factors are associated with their digital health use, such as age, education, geography, as well as health conditions including cancer, diabetes or a heart condition, which are among the top causes of mortality for Black adults. We looked at how people access health information online – such as watching health-related YouTube videos or consulting an app to make a health decision; how they generate information online – such as sharing health information on social media or using health tracking devices to support a goal like losing weight; and how people interact online with clinical systems or healthcare providers to schedule or access test results.
We used a nationally representative sample of data from the Health Information National Trends Survey from 2017 to 2020 to analyze these behaviors.
The results are clear: If we want Black adults to effectively use digital health tools, these tools must take into account age, education, income, geographic realities and key health conditions at the very least. Further, owning a smartphone does not mean a person is accessing digital health tools.
If we want Black adults to effectively use digital health tools, tools must take into account age, education, income, geographic realities and key health conditions at the very least.
The data also show that older Black adults and those with less education will likely need additional resources to use digital health tools to their full capacity. Middle-aged Black adults 30-49 years old were highly engaged in clinical and non-clinical digital health activities like tracking health goals and using apps to help make medical decisions, which suggests that this group may benefit from more integrated digital health platforms that include goal tracking, online health information seeking, and direct provider communication. Such integration could support both individual self-management and interpersonal-level prevention and disease management.
Younger Black adults were more likely to share health information through social media. Younger or middle-aged Black smartphone owners were more likely to engage digital health tools, and Black adults with lower education levels reported lower engagement levels with digital health.
What are your future research plans?
In 2025 I created the dig-Inclusive Lab (pronounced “dij-Inclusive,” like "digital"), a research lab dedicated to exploring how consumers use digital health tools both within and beyond clinical settings, particularly among underserved and minoritized communities. The lab examines how digital health tools support health and health-promoting behaviors.
The core of the dig-Inclusive Lab is built on community engagement, including collaboration to co-design and involve community input, evaluate and refine digital health tools that align with their values, beliefs and lived experiences. By centering community voices, this lab aims to ensure that digital health innovations are accessible, culturally relevant and effective.