Telemedicine in Late 2025: Hybrid Care, Power, and Practice in a Digitally Stratified World

Author: Al Souleiman, Ibrahim

ORCID ID: 0009-0002-9521-4847

Affiliation: VBNN Smart Education Group

https://doi.org/10.65326/u7y566746

Received 5 Sep 2025; Revised 20 Sep 2025; Accepted 25 Oct 2025; Available online 12 Nov 2025; Version of Record 12 Nov 2025; Post-Publication Update 5 Jun 2026.

Volume 2, December 2025, (10022) 

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Abstract

Telemedicine entered late 2025 as an ordinary, if uneven, part of health systems, well past the emergency footing of the pandemic years. Three research literatures speak to this state of affairs with little contact between them: health-services work on the design and effectiveness of hybrid care, public-health work on the digital divide, and critical social science on platformization and the datafication of care. Each sees something real, yet none reads the post-pandemic arrangement as a single object that distributes care, authority, and health chances together. This article builds that reading through a theoretically guided integrative synthesis of peer-reviewed and policy literature from 2014 to 2025. Working from the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework and from critical digital health and platform scholarship, it examines the present settlement along three linked axes—practice, power, and stratification—and sets out six propositions. Hybrid care, on this account, is where delivery has come to rest, not a stage on the way to something else. Audio-only contact has hardened into a lower-status track. Platform mediation turns the clinician–patient dyad into a clinician–patient–platform triad. Regulatory volatility is a standing structural condition, and it is absorbed unequally across providers. The access gains telemedicine delivers are conditional, and at the margin they favor groups already well served, so hybrid care can widen relative inequities when nothing is done to prevent it. The wider aim is to bring implementation science into contact with the political economy of digital health, extending NASSS toward questions of power and distribution and recasting the access debate around the digital determinants of health.

Keywords: telemedicine; hybrid care; digital divide; digital determinants of health; platformization; health equity; NASSS framework

1. Introduction

The coronavirus pandemic forced a global, involuntary experiment in remote care. Services that had resisted decades of incremental reform moved online within weeks, and telemedicine went from a marginal channel to the main point of contact between patients and clinicians (Wosik et al., 2020; Mann et al., 2020). That emergency is now over, and what has taken its place is a stable but partial use of remote care, folded into routine delivery beside in-person visits. It is no longer the fringe service of the pre-2020 years. Nor did it remain the near-total substitute it briefly became in 2020. It settled somewhere in between, and there it has stayed.

The usual name for this arrangement is “hybrid care.” The term is convenient and a little misleading. It implies an even blend of two modalities, when what actually happens is a contested set of decisions—which encounters go remote, which go by video and which by telephone, and for whom—taken under clinical, organizational, commercial, and regulatory pressures that often point in opposite directions (Greenhalgh et al., 2017; Valdes et al., 2025). To understand hybrid care, then, it is not enough to ask whether it works clinically. The harder question is how the arrangement hands out resources, authority, and benefit.

Three bodies of scholarship describe the post-pandemic landscape, each from its own vantage point. Health-services and implementation research asks about effectiveness, workflow redesign, and the conditions under which technology-supported change lasts; the NASSS framework and the studies of video-consultation implementation are representative (Greenhalgh et al., 2017; Abimbola et al., 2019; Wherton et al., 2020; Eze et al., 2020). Public-health research on the digital divide tracks who uses telemedicine and who does not, documenting gaps by race, income, language, geography, and age (Eberly et al., 2020; Rodriguez et al., 2021; Chen, 2025; Shah et al., 2024). Critical social science, for its part, theorizes platformization, datafication, commodification, and surveillance as properties of contemporary health technology (Lupton, 2014; van Dijck & Poell, 2016; van Dijck et al., 2018; Sadowski, 2019; Zuboff, 2019).

These conversations rarely meet. Implementation research can say whether and how a technology is adopted and sustained, but it tends to hold power and distribution off to the side, as background rather than as something to be analyzed. Equity research is precise about who gets left out, yet it often casts that exclusion as an access gap waiting to be closed, when it may be a structural feature of a system that is platform-mediated, commercially run, and politically contingent. Critical scholarship has the sharpest account of power and the thinnest grip on the actual clinical arrangement hybrid care has become. The gap left between them is the one this article takes up: no existing account reads the late-2025 configuration all at once as a way of organizing practice, a distribution of power, and a force that stratifies. Since the same design and policy choices produce all three, studying them apart gives a distorted picture of how the settlement works.

The reading offered here runs along those three linked axes—practice, power, and stratification—and is stated as a set of propositions open to empirical test. No new primary data are reported; the work synthesizes existing evidence under an explicit theoretical lens. Its central claims are that hybrid care is the settled equilibrium of present-day delivery, that this equilibrium pulls authority toward the platforms and payers that now sit between clinician and patient, and that its benefits fall, absent intervention, along the lines of existing advantage and can deepen them. Three contributions follow. The NASSS framework is extended by raising power and distribution from background conditions to cross-cutting axes. Implementation science is connected to the political economy of digital health. And the equity debate is moved off the language of closing an access gap and onto the governance of the digital determinants of health (Chidambaram et al., 2024). The sections that follow describe the post-pandemic settlement, set out the framework and method, present the synthesis and its propositions, and draw out what the argument means for theory and for the debates it joins.

2. The Post-Pandemic Settlement

Before 2020, telemedicine made up a negligible share of clinical encounters in most health systems. The pandemic changed that abruptly, and although volumes later fell from their peak, they came to rest well above the old baseline (Decker et al., 2024). Where they came to rest is not uniform across clinical domains. Remote care clusters in services that suit it, above all behavioral and mental health, where virtual contact is now the main mode and no longer a supplement (Decker et al., 2024; Cummings et al., 2024). The settlement is therefore selective: telemedicine is now normal for some kinds of care and marginal for others.

In high-income systems the prevailing form is hybrid. Most providers now mix in-person and remote contact and assign each according to the condition, the task at hand, and the patient’s circumstances, moving to physical examination when remote assessment falls short (Wherton et al., 2020; Valdes et al., 2025). This act of allocation is what contemporary practice largely consists of, and it is the point at which clinical judgment, operational pressure, reimbursement rules, and a patient’s own capabilities all bear down at once. The global picture is less tidy. Across many low- and middle-income countries the path has been set by mobile-first infrastructure, unreliable connectivity and power, and unsettled regulation, yielding adoption patterns some distance from the high-income template (Mahmoud et al., 2022; Agbeyangi & Lukose, 2025; Ummer et al., 2025; Kruse et al., 2018).

The settlement also turns on politics. In the United States, the pandemic-era flexibilities that made broad reimbursement possible were kept alive by a run of short-term legislative extensions, each leaving open the question of whether and how remote services would go on being paid for (Decker et al., 2024; Becevic & Mehrotra, 2024). Reimbursement is the variable that governs the rest: it sets which remote services are financially viable and therefore which survive. A configuration that looks stable in the aggregate is, looked at more closely, propped up by temporary arrangements that could move it again.

3. Conceptual Framework

The analysis joins two traditions that seldom sit together. One is the implementation-science account of complex health technologies, of which the NASSS framework is the leading example. NASSS explains nonadoption, abandonment, and the difficulties of scale-up, spread, and sustainability across seven interacting domains—the condition, the technology, the value proposition, the adopter system, the organization, the wider system, and the way these embed and adapt over time (Greenhalgh et al., 2017; Abimbola et al., 2019). Its strength is a multilevel, sociotechnical realism that shows why technologies which shine in pilots collapse at scale, and why staying power depends on alignment across domains. Its limit, for the present purpose, is that the “wider system” and the “value proposition” enter as conditions to be managed, when they are also arenas in which power and distribution are fought over. NASSS can tell us whether a technology is sustained. It is less suited to telling us on whose terms, and for whom.

The other tradition is critical digital health and platform scholarship. Lupton (2014) treats digital health technologies as socio-technical artifacts rather than neutral instruments: they remake the patient, push responsibility for health onto the individual, and turn the body and the encounter into data. van Dijck and Poell (2016) and van Dijck et al. (2018) describe a platform society whose organizing mechanisms—datafication, commodification, selection—reach into public sectors, health care among them, setting public values against the interests of platform owners. For Sadowski (2019), data is a form of capital, accumulated and extracted like any other; for Zuboff (2019), behavioral data anchors a whole economic order. What this body of work offers is exactly what NASSS leaves out: a language for the power relations and the political economy surrounding the technologies whose adoption implementation science studies.

A third strand ties these traditions to the question of distribution. The idea of digital determinants of health names a distinct class of determinant—access to devices and connectivity, digital and health literacy, and the biases built into technology design—that overlaps with the familiar social determinants and can amplify them (Chidambaram et al., 2024). Studies of digital and health literacy among older and disadvantaged populations give the idea empirical weight (Shi et al., 2024; Hepburn et al., 2025; Bertolazzi et al., 2024).

Put together, the three traditions yield three analytic axes. Practice covers how care is configured and delivered—how modality is assigned and how the encounter itself changes—and lies closest to implementation science. Power covers how authority, value, and control are shared out among clinicians, patients, platforms, and payers, and draws on the platform and critical digital health literatures. Stratification covers how access and benefit fall across populations, and draws on the work on digital determinants and equity. The framework’s central claim is that the three are not independent: a single decision about hybrid workflow is at the same time a clinical choice, an allocation of power, and a distribution of health chances. Table 1 sets this out.

Table 1. An integrative framework for reading telemedicine: three axes

Axis	Guiding question	Anchoring concepts	NASSS domains most engaged
Practice	How is care configured and delivered, and how is the encounter changed?	Hybrid allocation; triage logic; video and audio-only modalities; clinician–patient interaction	Condition; technology; adopter system; embedding over time
Power	How are authority, value, and control distributed among the actors that mediate care?	Platformization; datafication; commodification; surveillance; reimbursement governance	Value proposition; wider system; organization
Stratification	How are access and benefit distributed across populations?	Digital determinants of health; digital and health literacy; broadband and device access	Adopter system; wider system; embedding over time

Note. The framework treats the three axes as interdependent rather than separable: a single design or policy choice typically operates on all three at once. The NASSS framework (Greenhalgh et al., 2017) refers to the nonadoption, abandonment, scale-up, spread, and sustainability framework; the mapping in the final column indicates which of its seven domains each axis most directly engages, not an exclusive correspondence.

4. Method

The study is a theoretically guided integrative synthesis. The design suits a problem that calls for integrating disparate evidence and building theory, not for pooling a quantitative effect. It fits here for two reasons: the research question crosses clinical, social-scientific, and policy literatures whose methods and outcomes do not reduce to a common measure, and the aim is conceptual integration and the development of propositions. The approach has precedent in the field, including NASSS-based interpretive syntheses of telemedicine sustainability (Valdes et al., 2025) and integrative reviews of digital health adoption (Bertolazzi et al., 2024).

4.1 Selection logic

Sampling was purposive and concept-driven, not exhaustive. The point was to cover the three literatures defined above with analytic adequacy, not to enumerate every telemedicine publication. Sources fell into three strata. The first holds the foundational conceptual works that supply the analytic lenses, chosen for their standing in implementation science and critical digital health (e.g., Greenhalgh et al., 2017; Lupton, 2014; van Dijck et al., 2018; Zuboff, 2019). The second holds recent reviews and strong empirical studies of telemedicine practice, equity, and outcomes from 2020 onward, chosen to characterize the post-pandemic settlement (e.g., Decker et al., 2024; Ettman et al., 2025; Valdes et al., 2025). The third holds studies that carry the analysis beyond high-income settings, chosen to test how far the framework reaches (e.g., Mahmoud et al., 2022; Agbeyangi & Lukose, 2025; Ummer et al., 2025).

The window ran from 2014 to 2025, with the foundational theory drawn from its earlier years and the empirical evidence on the settlement concentrated between 2020 and 2025. Sources were included if they were peer-reviewed and addressed telemedicine or telehealth practice, equity, or political economy; if they were systematic, scoping, or integrative reviews; if they were empirical studies of disparities or outcomes whose findings transferred beyond a single site; or if they offered conceptual purchase on one or more of the three axes. Sources were excluded if they lacked a clear methodological or conceptual contribution, if they were promotional or vendor material, or if they were single-setting descriptive reports with nothing transferable to offer.

4.2 Analytic procedure

The principal claims of each source were coded thematically and compared across the three strata by constant comparison, and the resulting themes were mapped onto the practice, power, and stratification axes. Propositions were developed abductively, moving back and forth between the assembled evidence and the theoretical lenses until a statement accounted for the pattern at hand. Where independent sources converge, the proposition is presented as empirically grounded. Where a claim reaches past the direct evidence into interpretation, it is labeled as interpretive. Keeping the two apart lets a reader see how much weight each proposition can bear.

4.3 Scope and stance

This is a high-level interpretive reading, not a PRISMA-type systematic review, and what it seeks is analytic generalization—propositions that transfer—rather than statistical generalization. Two boundaries matter. The evidence base leans toward high-income systems, the United States most of all, where the disparity and policy data are richest; the low- and middle-income studies are brought in to test the framework, not to establish it. And the reading is interpretive, so other framings of the same evidence remain possible. Both points return in the limitations.

5. Findings

5.1 Practice: hybrid care as equilibrium

The most basic finding is that hybridity is where delivery has settled, not a way station between in-person and virtual care. Use stabilized above the pre-pandemic baseline and organized itself around matching modality to clinical need (Decker et al., 2024; Valdes et al., 2025). Providers triage: some encounters go to video, some to telephone, some to in-person assessment, with movement between them as the clinical situation demands (Wherton et al., 2020). Behavioral health shows the logic plainly. Where the work of the encounter is mostly talk, remote delivery holds; where a physical examination is central, it does not (Cummings et al., 2024; Decker et al., 2024).

Proposition 1. Hybrid care is the equilibrium of post-pandemic delivery: a triaged arrangement in which modality is allocated by clinical and operational logic, stable in its own right and not a transitional phase between virtual and in-person care.

Audio-only care is a second durable feature. Telephone contact held on to a sizable share of remote encounters, and it falls disproportionately to patients without the connectivity, devices, or confidence for video—older, lower-income, rural, and limited-English-proficiency groups among them (Eberly et al., 2020; Rodriguez et al., 2021). The telephone does two things at once. It extends reach to people who would otherwise go unseen, and it carries a lower status, with thinner and more contested reimbursement and a steady undertone of doubt about its clinical adequacy, even though for some patients it is the only option that works. What emerges is a second, lower tier running inside the hybrid system.

Proposition 2. Audio-only care persists as a lower-status track that extends reach while hardening a division between video-capable and audio-only populations.

Hybrid practice also reshapes the encounter itself. Syntheses of patient and clinician experience report that remote contact keeps access open and is broadly acceptable, while changing the texture of the encounter in subtler ways—how an examination is conducted, how non-verbal cues are read, how rapport is built and held (Valdes et al., 2025; Wherton et al., 2020). The changes do not run all one way. Whether they help or hinder depends on the condition, the modality, and the relationship between the people involved.

5.2 Power: platforms, data, and governance

Once care moves online, it runs on infrastructure that someone owns and governs. Most telemedicine today is delivered through commercial platforms and the data systems bolted to them, and the critical digital health literature is clear about what that introduces: the encounter is turned into data, that data becomes a resource to be accumulated and used, and the platform’s design quietly sets the limits of what clinicians and patients can do (Lupton, 2014; van Dijck & Poell, 2016; Sadowski, 2019). None of this is confined to consumer wellness apps any longer. It operates inside routine clinical care.

The consequence is best put structurally. The clinical relationship has long been theorized as a dyad: clinician and patient. Platform mediation slots in a third party with its own interests, capabilities, and claims over the data the encounter produces, turning the dyad into a clinician–patient–platform triad. Add automated decision support and remote monitoring and the non-human participants multiply further. With each addition, a share of clinical authority, and of the value created in care, moves away from the clinical relationship and toward whoever owns the mediating infrastructure.

Proposition 3. As care is mediated by commercial platforms and datafied, a share of clinical authority and value moves from the clinical relationship to platform owners, turning the clinician–patient dyad into a clinician–patient–platform triad. (Interpretive: consistent with platform and critical digital health scholarship; not yet directly quantified for routine telemedicine.)

This shift matters all the more because so much of the care involved is publicly funded or publicly accountable. Public values—equity, privacy, continuity—are thereby set against the commercial logics of datafication, commodification, and selection (van Dijck et al., 2018; Zuboff, 2019). The strain is not hypothetical. It shows up in disputes over who owns clinical data, how it may be reused, and how the design of a platform steers clinical behavior.

Power is also exercised through governance, and regulatory volatility belongs in the analysis as a structural condition of the settlement in its own right. The run of short-term reimbursement extensions in the United States, and the wider uncertainty about the scope and payment of remote services, decides which organizations invest in telemedicine, which services they keep, and which they let go (Becevic & Mehrotra, 2024; Decker et al., 2024). In NASSS terms this lives in the “wider system” domain, but to read it only as complexity is to miss what it is. The volatility is absorbed unevenly: well-capitalized organizations can hedge against it, while smaller and safety-net providers, and the patients who rely on them, carry the risk.

Proposition 4. Regulatory and reimbursement volatility is a standing structural condition of the settlement; it drives organizational investment and abandonment and is absorbed unequally, favoring providers able to carry uncertainty.

5.3 Stratification: who hybrid care serves

The equity literature is consistent on the existence of disparities in telemedicine use, by race, income, language, broadband access, and age (Eberly et al., 2020; Rodriguez et al., 2021; Chen, 2025; Shah et al., 2024; Girmay, 2024). For the present argument, though, the telling question is not whether disparities exist but how the benefits get distributed. A study of mental health care across levels of neighborhood deprivation found telehealth use tilting toward patients in less-deprived areas, with no sign of improved access for those in high-deprivation areas—evidence that telehealth did not widen access evenly and may hold existing disparities in place (Ettman et al., 2025). Systematic evidence on mental health and substance-use care lands in the same place, recording lower telehealth use among several underserved groups (Vakkalanka et al., 2024; Cummings et al., 2024).

The digital determinants of health name the mechanism behind this. Benefiting from a remote service takes more than its being on offer; it takes the connectivity, the device, and the digital and health literacy to use it, and all of these are socially patterned (Chidambaram et al., 2024). Work on older and disadvantaged populations shows how gaps in literacy and support turn an available service into uneven uptake (Shi et al., 2024; Hepburn et al., 2025; Bertolazzi et al., 2024). Because the necessary capabilities track existing advantage, a service offered uniformly is taken up most readily by those already better served. So telemedicine’s access gains come with conditions attached, and at the margin they run the wrong way: they accrue to advantaged groups, and unless something is done deliberately, hybrid care widens relative inequities instead of narrowing them.

Proposition 5. Telemedicine’s access gains are conditional on the digital determinants of health and, at the margin, distributionally regressive; without targeted intervention, hybrid care tends to widen relative inequities.

The low- and middle-income evidence both complicates and confirms the reading. Telemedicine can reach places where in-person services are thin, and mobile-first models have carried maternal, infectious-disease, and chronic care in several settings (Mahmoud et al., 2022; Agbeyangi & Lukose, 2025; Ummer et al., 2025). But those gains rest on infrastructure, governance, financing, and literacy, and where those supports are missing the same stratifying dynamic returns (Kruse et al., 2018; Eze et al., 2020). The pattern, in other words, is not an artifact of any one health system. It is what happens when remote care is offered into unequal social conditions.

5.4 Integration

The three axes cannot be pulled apart. Allocating a modality is at once a clinical decision, an allocation of power, and a distribution of health chances: sending a patient to an audio-only platform is a practice choice that also fixes what data are captured and by whom, and that bears on whether a disadvantaged patient is served well or merely served at all. To judge hybrid care on clinical effectiveness alone is to miss most of what it does.

Proposition 6. Practice, power, and stratification are mutually constituting in hybrid care: a single design or policy choice about remote workflow distributes clinical activity, power, and health chances all at once, and cannot be judged on clinical effectiveness alone.

6. Discussion

The argument speaks to three debates, and contributes something distinct to each.

The first is implementation science, and the move is to extend NASSS. The framework asks whether complex health technologies are adopted and sustained, and answers through alignment across its seven domains (Greenhalgh et al., 2017; Abimbola et al., 2019). The reading here adds two questions it can hold but does not foreground: for whom is sustainability achieved, and on whose terms. Once power and distribution are treated as cross-cutting axes instead of conditions tucked inside the “wider system” and “value proposition” domains, the framework can name a pattern it otherwise leaves invisible—a technology that is thoroughly sustained while its benefit concentrates. Hybrid care shows that durability and equity are separate properties: an arrangement can be deeply embedded and reliably funded and still hand out its gains regressively (Ettman et al., 2025). Interpretive syntheses that already put NASSS to work on telemedicine sustainability lean this way; the framework offered here makes the step explicit (Valdes et al., 2025).

The second debate sits between implementation science and the political economy of digital health, and the move is to bridge them. The platform-society literature theorizes datafication, commodification, and selection at the scale of sectors and economies (van Dijck & Poell, 2016; van Dijck et al., 2018; Sadowski, 2019; Zuboff, 2019); the critical digital health literature theorizes the remade patient and the surveillant logic of health technology (Lupton, 2014). Neither is often brought up against the fine-grained evidence on how routine remote care actually runs. Placing those mechanisms inside the hybrid encounter, and naming the clinician–patient–platform triad, hands health-services audiences a working vocabulary for power and hands critical scholars a concrete clinical site where their constructs can be watched and tested.

The third debate is about equity, and the move is to reframe it. A common and intuitive view holds that more telemedicine means more access, so expanding remote care is itself a gain for equity. The strong version of that claim does not survive the evidence. When benefit depends on socially patterned capabilities, expanding a service uniformly can widen inequity rather than close it (Eberly et al., 2020; Rodriguez et al., 2021; Vakkalanka et al., 2024; Ettman et al., 2025). The sturdier framing treats the digital divide as one face of the digital determinants of health—structural, and in need of active management—rather than a passing access gap that growth alone will erase (Chidambaram et al., 2024). Availability, on this view, is necessary and not sufficient, and the question worth posing to policy shifts from how much telemedicine is on offer to how its benefit is shared.

There is a fourth debate in the background, over the clinical relationship, and the argument refuses both of its poles. Remote care does not simply extend the reach of an unchanged practice, as the optimists have it, and mediation does not inevitably corrode the encounter, as the pessimists fear. Hybrid care is equalizing or corrosive by turns, depending on how the three axes are governed together. Several practical orientations follow. Modality choice is a distributive decision and should be treated as one, not only as a clinical preference. Audio-only care warrants parity of esteem and funding wherever it is the accessible option, even as the work of widening video capability continues. Platform governance, data rights, and procurement deserve to be handled as instruments of public value, not technical afterthoughts (van Dijck et al., 2018). Reimbursement stability earns its place on the agenda precisely because the volatility is borne unequally (Becevic & Mehrotra, 2024). And literacy support and assisted-access models are needed to stop a uniform offer from producing uneven uptake (Shi et al., 2024; Hepburn et al., 2025). In low- and middle-income settings the binding constraints lie in infrastructure, financing, and governance well before they lie in the technology (Mahmoud et al., 2022; Eze et al., 2020).

7. Limitations

Three limitations bound the argument. It is an interpretive, purposive synthesis and makes no claim to be exhaustive; a different slate of sources could shift the emphasis, though the way independent disparity studies converge gives the central claims some resilience. The evidence is also weighted toward high-income systems, the United States in particular, where the policy and disparity data are richest, so the low- and middle-income literature serves to probe the framework’s reach more than to ground it, and the framework’s transfer to those settings will need direct study. Finally, the propositions are analytic, not tested. The claim that platform mediation redistributes authority and value (Proposition 3) is consistent with the theoretical literature but has not been quantified for routine telemedicine, and stands here as a hypothesis for empirical work. Because reimbursement policy moves quickly, particular regulatory arrangements will keep changing even as the structural role of volatility holds.

8. Conclusion

By late 2025 telemedicine has settled into a durable hybrid form that does three things at once: it delivers care, it redistributes power, and it sorts who benefits. Read along the linked axes of practice, power, and stratification, these turn out to be aspects of a single arrangement, produced by the same design and policy choices, and not three separate problems. The case made here is that hybrid care is the equilibrium and not a passing phase; that audio-only care endures as a lower-status track; that platform mediation remakes the clinical relationship as a clinician–patient–platform triad; that regulatory volatility is a structural condition borne unequally; and that the gains of remote care are conditional on the digital determinants of health and, at the margin, regressive. Holding these together means joining three literatures that have grown up apart: extending NASSS toward power and distribution, connecting implementation science to the political economy of digital health, and moving the equity debate from closing an access gap to governing the digital determinants of health. The questions that matter about telemedicine are no longer whether it works, but how its hybrid form is governed, and for whom.

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Telemedicine in Late 2025: Hybrid Care, Power, and Practice in a Digitally Stratified World

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