Digital Health Literacy Classes

Many of the Afghans displaced by the Taliban takeover of Kabul in 2021 found refuge in the United States through Operation Allies Welcome (OAW) and the ongoing Operation Enduring Welcome (OEW) Response. OAW was an interagency initiative that coordinated efforts across the federal government, military, state and local governments, NGOs, and private partners to manage the resettlement of nearly 90,000 Afghans. As Afghan newcomers began arriving in the U.S. in 2021 amidst the COVID-19 pandemic, resettlement agencies worked alongside the federal offices, healthcare systems, public health departments, social service providers, and community-based organizations to provide much-needed assistance.

Resettled Afghans are acclimating to life in the United States, enriching their new communities, securing public benefits and seeking opportunities for their families. At the same time, they are experiencing ongoing challenges related to the trauma of sudden displacement and navigating complex systems like health care as English-language learners.

Digital Health Literacy Needs of Afghan Refugees in the U.S.

Many Afghan newcomers need support navigating the U.S. healthcare system due to the system’s complexity and limited English proficiency. The U.S. healthcare system’s rising use of digital communication through patient portals and telemedicine appointments increases barriers to needed health information and support. Many Afghan newcomers may lack computer equipment, internet access, and the digital literacy required to use these tools effectively. To address these barriers, providing customized digital health literacy support is essential in equipping newcomers with the basic skills to navigate the U.S. healthcare system, access resources, and make informed health decisions.

IRC Spokane’s Digital Health Literacy Classes

The IRC Spokane office opened in April 2022 and has received around 180 Afghan newcomers. However, the number of Afghan newcomers resettled in Spokane is likely higher, as the IRC also serves many who arrived through other agencies. In March 2023, IRC Spokane conducted a month-long community needs assessment involving conversations with Afghan community members, key community leaders, and staff from Afghan backgrounds and surveys administered during community gatherings such as a women's day celebration event. The needs assessment results showed that many members of the Afghan community needed access to technology and digital skills to engage with health systems, schools, and other essential resources.

To address the challenges raised by the needs assessment, IRC Spokane launched the Digital Health Literacy program in June 2023 as part of their existing Health Education program. The program's primary goal was to teach clients how to use digital platforms like MyChart and Canvas to navigate medical and academic services online. However, after a few classes, the IRC staff realized that many clients needed more basic digital skills. As a result, a five-week class was developed to focus on teaching these foundational digital skills.

To ensure everyone has equal access to the necessary technology, IRC Spokane partnered with InterConnection. Through computer refurbishment, this non-profit organization provides affordable technology, connectivity, and digital skills training to underserved communities globally. To date, the IRC Spokane office has provided 240 laptops and desktops for its clients to have personal devices to fully engage in hands-on learning and apply the digital skills they acquire. This was made possible through local fundraising efforts that allowed IRC Spokane to purchase the devices from InterConnection at a reduced nonprofit rate.

To further increase accessibility, IRC Spokane partnered with Manzanita House, a non-profit organization that provides a physical space for classes and offers immigration and legal services and heritage language classes to immigrants and refugees. This partnership evolved due to budget constraints for transportation and childcare. Manzanita House's prime location within a community center that houses a library, clinic, and welcome center ensures easy access for program participants to utilize these complementary facilities and services, even though Manzanita House itself does not directly provide them. Additionally, a dedicated "kids' corner" for parents attending the classes is set up to allow them to focus on learning without childcare concerns. Through these strategic partnerships, IRC Spokane has ensured that the digital health literacy program is accessible and inclusive, removing potential barriers and enabling participants to engage in the learning process fully.

The digital health literacy program is facilitated by IRC staff with expertise in digital literacy, and at least one Afghan staff member is present to provide language and cultural support. Interpretation services are also provided to ensure that everyone can fully engage with the content, and the class size is limited to allow for personalized attention and maximize learning outcomes.

The curriculum was developed in collaboration with the digital equity team in IRC Spokane. The curriculum consists of one 90-minute class per week for five consecutive weeks, covering the following topics:

  1. Introduction to Your Device: Learn how to turn on a device, charge it, connect to Wi-Fi, distinguish between URLs and searches, and practice internet safety. 
  2. Email: Discover how to set up a Gmail account and effectively use email. 
  3. Zoom: Master setting up a Zoom account, joining calls, and practicing Zoom etiquette (e.g., muting, camera controls, chat function). This topic is crucial for telehealth appointments due to medical and educational professionals' widespread use of Zoom. 
  4. Google Maps: Explore navigation and learn how to find contact information, hours of operation and nearby services like urgent care or pharmacies. Clients also learn how to install Google Translate browser extensions for their language. 
  5. Developing a “Service Access Plan”: Implement the lessons learned through classes by creating a “Service Access Plan,” close to a 10-page physical address book where participants can access their personal or family member's medical information, like providers (primary care, dentists, etc.), teachers, and key contacts, along with contact information and appointment-making steps for everyone. The packet also includes a section for participants to note the nearest urgent care and emergency room locations, directions on reaching them, and additional details such as online waitlist options for urgent care appointments.

The classes have primarily attracted female participants, not due to the program's design but through self-selection. Dempsey, the Digital Health Education Coordinator at IRC Spokane, attributes this to Afghan women's greater need for digital literacy skills and the fact that they are not joining the workforce as quickly as men. IRC Spokane designed small group classes to accommodate married couples, encouraging participation from all genders. This personalized session format provided a tailored learning experience.

As of March 2024, the digital health literacy program has conducted six cohorts of group classes and offered one-on-one tutoring to additional individuals. The program measures its success by the increase in clients' self-reported understanding of digital literacy tasks, assessed through the difference in composite scores from pre- and post-assessments. According to Dempsey, the program has "seen very consistent improvement from pre- to post-test." The 2023 annual report indicated positive outcomes, with 87 individuals completing the digital literacy classes and demonstrating improved digital literacy skills based on pre- and post-assessments.

Keys to Success

  • Strategic Partnerships: Collaborations with community centers like Manzanita House and organizations like InterConnection showcase effective resource utilization and support for participants, setting a replicable model for enhancing digital access and literacy. 
  • Resource Provision: Providing laptops to clients removes technology barriers, facilitating seamless learning experiences and access to healthcare resources without obstacles. 
  • Customized Digital Literacy Support: Tailoring classes and one-on-one coaching to diverse literacy levels ensures all participants acquire essential digital skills for navigating the healthcare system effectively, with trained volunteers offering personalized learning experiences. 
  • Participant Engagement: Identifying and utilizing individuals with advanced digital skills to assist their peers reduces the instructor’s workload, fosters a supportive learning environment, and may lead to some participants formally volunteering after showcasing their expertise.
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