How do we better serve excluded populations when delivering digital health technology? Inclusion evaluation of a digital musculoskeletal self-management solution

Berry, Alice

Abstract

Background
Digital self-management platforms have been proposed as a solution to better support people manage their musculoskeletal (MSK) condition. However, there is a lack of evidence supporting its effectiveness and trials often explicitly exclude people who can’t access internet connected devices. An important consideration is that digital exclusion (for people without access to an internet connected device) from these new digital options will worsen already existing inequality in healthcare. The importance of this is highlighted by the fact that MSK pain and disability has a disproportionate impact in areas of economic deprivation and on minor ethnic groups.

Aim
To evaluate the acceptability and potential causes of digital exclusion of the South West London (SWL) MSK self-management app.

Objectives
1 a) Explore why some patients are not using the app and any barriers they have.
b) Explore why some clinicians are not prescribing the app.
2 Make recommendations, based on these findings, to improve digital inclusion.


Methods

Design
An explanatory sequential mixed methods service evaluation consisting of initial questionnaires to identify suitable collaborators followed by structured interviews of patients and clinicians
Phase 1.
A questionnaire was developed to assess the ‘acceptability’ of the SWL MSK app for patients and clinicians. We used the London Office of Technlogy & Innovation data, map and personas to identify areas with SWL with high levels of potential digital exclusion, and matched people who found getUBetter less acceptable to these areas. Clinician Interviews were targeted by questionnaire returns and prescription rates.
Phase 2 .
Interviews were then carried out to gain a deeper understanding for potential reasons for digital exclusion.

Results
256 people responded to the initial questionnaire. Of these we took 11 patients and 11 clinicians to interview. Following a comprehensive data analysis, 10 sub-themes were grouped into 4 main themes:
1) Beliefs: Importance of understanding the role of digital; Face to face consultation is still valued and needed.
2) Barriers: Lack of digital literacy; Lack of physical examination/contact with a clinician.
3) Enablers: Immediate access to advice/information; Perceived better control over health; Ease of use; No appointment needed
4) Solutions: Support and training; Greater awareness

Conclusion(s)
The project will enable an existing digital technology to be adopted by more patients as the technology design and delivery can be adapted to address the causes of digital exclusion we have identified from the perspective of people using the technology and clinicians prescribing it. Although service providers and digital health technology companies have a duty to address health inequalities and digital inclusion, a broader response is needed at a societal level.

• Presentation Conference Type: Poster
• Conference Name: Royal College of General Practitioners Annual Conference
• Start Date: Oct 3, 2024
• End Date: Oct 4, 2024
• Acceptance Date: Oct 1, 2024
• Deposit Date: Feb 17, 2025
• Peer Reviewed: Peer Reviewed
• Public URL: https://uwe-repository.worktribe.com/output/13763311