Strategies to promote digital health equity

Abstract

Digital Health Technologies (DHTs) have revolutionised healthcare, but their benefits are not equally experienced among under-served populations. This PhD project aimed to identify those most at risk of digital exclusion within healthcare and explore strategies to promote inclusivity. First, the researcher reviewed the literature to identify sociodemographic factors that may contribute to digital exclusion within healthcare, organising them into six groups to form the CLEARS framework (Culture, Limiting conditions, Education, Age, Residence, and Socioeconomic status), which recognises intersectionality across these groups (Chapter 3). This review also highlighted a knowledge gap around the needs and experiences of under-served groups, and the strategies that might support their digital inclusion. Inspired by this, the researcher conducted a systematic review of the literature to identify strategies to promote digital health equity (Chapter 4). The review highlighted the importance of user-friendly designs, supportive infrastructure (e.g., free devices and connectivity), and digital skills educational support. A qualitative study, using semi-structured interviews and focus groups, was conducted with 29 under-served individuals who represented the CLEARS groups to explore their perspectives of these strategies (Chapters 5-6). Participants raised concerns regarding the use of their social network for digital skill support (e.g., experiencing controlling behaviours) and highlighted the need to increase funding for educational support services. Co-design approaches were also suggested to ensure DHTs were designed appropriately and tailored to meet users’ needs. To understand whether these digital inclusion strategies are feasible at a local or regional level, the researcher conducted a second qualitative study with 17 stakeholders who had a professional interest in making decisions and/or delivering activities to support under-served groups at risk of digital exclusion (Chapter 7). Stakeholders emphasised the need for cross-organisational collaboration to implement free devices and connectivity, which were resource intensive. They also stressed the need for staff training to upskill healthcare professionals and develop a knowledge base of local digital inclusion support that under-served groups can be referred to. Based on all the findings from this PhD programme of work, the researcher created eight key recommendations to advance digital inclusion within healthcare, including co-designing DHTs with user involvement, raising awareness of available support amounts under-served communities, and providing various digital inclusion support services (e.g., educational digital skills support, re-purpose devices and pre-paid SIM cards). Further research should assess the feasibility and impact of these recommendations in practice.