Redefining and Solving the Digital Divide and Exclusion to Improve Healthcare: Going Beyond Access to Include Availability, Adequacy, Acceptability, and Affordability

Laronda A. Hollimon Kayla V. Taylor Rachel Fiegenbaum Mary Carrasco Laurent Garchitorena Gomez Debbie Chung Azizi A. Seixas ^*

• Leonard M. Miller School of Medicine, University of Miami, Miami, United States

The digital divide extends beyond mere access to devices and the internet, yet policies often fail to address broader barriers to digital inclusion. To bridge this gap, we propose the Rhizomatic Digital Ecosystem Framework, which comprises five interdependent components: access, availability, adequacy, acceptability, and affordability. This framework captures the complexity of the digital divide and offers a comprehensive solution to eliminate digital disparities. Access highlights the need for physical infrastructure and assets, leading to initiatives such as the Broadband Equity, Access, and Deployment (BEAD) Program, which expands connectivity in underserved areas. Availability ensures the presence of reliable infrastructure to meet community needs, with targeted policies such as satellite-based solutions improving access in rural and Indigenous areas. Adequacy assesses whether internet services meet modern demands, including telehealth and online education, emphasizing the need for minimum speed standards and service improvements. Acceptability tackles cultural and social barriers, such as digital literacy gaps, language differences, and technophobia, which can be addressed through localized literacy programs and inclusive design practices. Affordability addresses financial barriers, as many low-income households struggle with internet costs even with subsidies like the Affordable Connectivity Program (ACP). Together, these five dimensions provide a nuanced and actionable framework for crafting effective policies and solutions. By addressing each component through the Rhizomatic Digital Ecosystem Framework, policymakers can develop holistic strategies to eliminate the digital divide and foster equitable digital inclusion across all communities, ensuring that digital access is not only available but also meaningful and sustainable.