Demystifying the digital divide and the role of information and communication technologies on health and disability in Australia

Demystifying the digital divide and the role of information and communication technologies on health and disability in Australia

Information and Communication Technologies (ICTs)today play a pivotal role in almost every sphere of human life. A growing body of literature has reported that ICTs have a substantial positive impact on the individual capabilities, productivity, employment and Gross Domestic Product (GDP) of nations. However, there are also concerns that uneven access to ICTs can exacerbate the extensity of digital inequality which makes policy discussions more complicated. Existing empirical analyses of digital inequality have mostly been conducted at the household, regional or global levels using cross-sectional study designs. In contrast, this thesis is based on state-wide longitudinal and nationally representative household-level cross-sectional and longitudinal survey data which have the potential to produce unbiased results and thus this can provide more empirical detail and reliability. Also, the long-term effect of digital inclusion on the Quality of Life (QoL) at the individual level has not received adequate attention in the existing body of knowledge. Further, existing studies are yet to explore the factors that affect the usage of ICT-enabled health services (particularly eHealth) among Persons with Disabilities (PwD). Given this backdrop, this thesis is aimed at exploring the underlying factors of digital inequality and the impact of digital inclusion on the QoL among PwD. To attain this broad objective, this thesis applied quantitative research approaches based on panel data estimation framework, causal mediation analysis, and cross-sectional data analysis. As the panel data estimation strategy, several methods have been applied including random effects(RE) model, panel dynamic ordinary least squares (DOLS) model, generalised linear mixed model (GLMM), two-stage instrumental variables (IV-2SLS) method and the full-information maximum likelihood (FIML) method. Besides, for the causal mediation analysis, this thesis applied both parametric causal mediation regression models and parametric mediation effect models. Meanwhile, for cross-sectional data-based analysis, the thesis employed a set of multivariate logistic regression models. These aforementioned quantitative techniques are deployed using several datasets including state-wide longitudinal dataset compiled by the Australian Bureau of Statistics (ABS), household-level longitudinal Household, Income and Labour Dynamics in Australia (HILDA) dataset and cross-sectional Survey of Disability, Ageing and Carers (SDAC).

The thesis is comprised of three major themes of study including ‘understating the predictors of the digital divide’, ‘impact of ICTs on health-related QoL’, and ‘ICT-enabled health service adoption among PwD’ in the Australian context. This thesis is a ‘PhD by publication’ and includes seven studies. These studies correspond to seven sub-themes which fall under three aforementioned broad themes. This thesis is underpinned by four interlinked theories: social exclusion, social capital and cognitive theories, capability theory and theory of digital inequality. Studies included under broad Theme I (Studies 1–3) explore the determinants and extent of the digital inequality in Australia and its association with socio-demographic inequality, income distribution and remoteness. Study 1finds that the digital divide is significantly associated with socio-demographic factors and remoteness in Australia. Results of Study 2 reveal that the ICT infrastructure and affordability concentrations are more prevalent in the areas of greater Sydney and greater Melbourne. Findings also indicate that the remoteness of spatial units has a substantial effect on the concentration. Findings of Study 3reveal that income distribution and socioeconomic inequality have a positive effect on ICT affordability. Theme II (Studies 4–5) of the thesis examines the direct and mediating effect of ICT on QoL. Findings from Study 4asserts that the association between digital inclusion and QoL is simultaneous. Study 5 evinced that ICT mediates between 61% and 73% of the impact of assistive technology on QoL among PwCD. Theme III (Studies 6–7) investigates the determinants of ICT usage for health care among PwD and elderly PwD. Taken together, results emanating from these studies confirm that age, gender, income, level of education, language proficiency and geographical remoteness are significant predictors of the use of ICT-enabled health care. The results also affirm that technological aspects have a stronger moderating effect on the usage of ICT-enabled health care than behavioural constraints. The policy implications emanating from the finding of studies included under Theme I are significant and straightforward. The results assert that digital divide is dependent upon several socio-demographic, economic and geo-spatial factors. To shape comprehensive digital inclusion policies, apart from enhancing ICT access by increasing efforts in building and spending on digital infrastructure, policymakers must take the socio-demographic factors of digital exclusion into account. Studies packaged under Theme II, confirm that digital inclusion can significantly contribute to the enhancement of QoL of general population as well as disadvantaged groups. However, to maximise the impact of digital inclusion on QoL, decision makers should particularly emphasise the improvement of digital abilities and affordability among users from disadvantaged communities including residents living in remote areas, PwD and elderly citizens. Findings from the studies included under Theme III (Studies 6–7) imply that to mitigate the digital disability divide, priority should be given to direct policies and targeted resource allocation to ease technological constraints.