Digital health covers a multitude of technologies, from wearable devices and medical mobile apps, to remote monitoring and AI. The rapid adoption of digital technology within health and social care has brought an abundance of opportunities to improve the way healthcare is delivered, but with those come a fair share of challenges. One of the main challenges the pandemic has exacerbated is the digital divide.
What is the digital divide?
The digital divide, also referred to as digital exclusion, is the gap between individuals who have access to digital technology and information and those who do not (Steele, 2019). Crucial steps need to be taken to close the divide, from ensuring as many people as possible have wi-fi access to educating them to be able to use digital devices like smartphones and computers. Meanwhile, digital services need to be engineered to be accessible for a wide range of user needs.
According to the UK Consumer Digital Index from Lloyds Bank:
people lack the basic skills to use the internet effectively
people are still completely offline
people have low digital engagement
Digital technology and the pandemic
Having access to digital technology enables us to easily carry out activities of everyday life. From grocery shopping and paying bills, to ordering prescriptions and connecting with friends, the world wide web empowers us to organise and enhance our lives with just a few clicks.
When the country went into lockdown, organisations were pressed to adopt more digital tools to continue operating. In turn, we were forced to become more reliant on technology in our everyday lives. It changed the way people work, socialise and how we access key services, especially healthcare (Age UK, 2021).
Despite the pandemic accelerating digital adoption, the divide has never been wider.
of UK citizens who are not online do not understand the benefits
of UK citizens not online say they are not interested in using the internet
increase (since 2020) in the number of people claiming that using the internet is too complicated
Digital technology in healthcare
Released in the summer of 2019, the NHS Long Term Plan placed a large emphasis on adapting digital technology in health and social care. In the 120-page document, the word ‘digital’ was mentioned 117 times. Numerous goals for utilising digital technology more often and more effectively were detailed, including giving patients the opportunity to have digital GP consultations. Little did we know, that just 6 months later, digital appointments would become the go-to solution for continuity of care.
Our health system’s growing reliance on digital tech reinforces the need to digitally include as much of the whole population as possible. According to Watts (2020), the adverse effects digital exclusion has on a person’s health is most likely due to the difficulty in accessing information and acting upon it.
Another reason that digital inequality and health inequality go hand in hand, is the psychological impact that exclusion can have (Watts, 2020). Feeling isolated and not being able to connect with friends and family online can have a crushing effect on people’s mental health. This would have been greatly exacerbated for people living in lockdown and isolation.
NHS perspective on the digital divide
According to NHS Digital, empowering patients to get online to be able to access digital health services and resources helps the NHS achieve key priorities, including:
- Health prevention
- Managing long-term conditions
- Enabling shared decision-making
- Aiding self-care
- Protecting physical and mental wellbeing
- Ensuring the appropriate use of emergency care
Who are most likely to be digitally excluded and why?
According to NHS Digital, the main groups of people at risk include:
- Older people
- People whose first language is not English
- People living on a lower income
- Unemployed people
- People living with disabilities
- People living in social housing
- Homeless people
- People with fewer educational qualifications
- People living in rural areas
People belonging to the groups listed above generally face more barriers to digital technology.
For example, a person from a low socio-economic background, living on a low income may struggle to afford the equipment needed to access digital technology, like a smartphone and broadband. This has come to be known as data poverty. The lack of access to internet data is a common barrier for disadvantaged groups in Scotland and Wales (Lucas, 2020).
Another example could be a person living with learning difficulties with poor literacy. They may struggle with filling in forms and accessing important information for their health.
It is worth noting that people who have poor literacy often have low health literacy, which is consistently associated with poor health outcomes (Jayasinghe, Upali W et al, 2016). From a lack of knowledge about medical conditions, to poorer use of preventative health services, these members of society are more likely to struggle to obtain good health.
How can we bridge the health digital divide?
Now that we understand the significance of digital exclusion and who is affected, we need to find ways to close the divide.
- Design with patients
Online services need to be designed with inclusion in mind. Developers need to try and walk in the shoes of patients to understand the digital barriers they face. The best way to achieve this is to work with patients to co-design digital tools that overcome pre-existing barriers and address their individual needs (NHS Providers, 2021). It is also important to involve healthcare professionals to ensure they can easily use the service, making it more likely that they will recommend it to patients.
- The power of words
To avoid excluding people, health organisations should pay particular attention to the language they use in digital services. Using language that is easy to understand is key – even the word ‘digital’ can scare people and lead them to disengage with the topic matter (Good Things Foundation, 2018).
“At the heart of every good digital product are user needs translated into a seemingly simple product that supports the user. Being able to describe a solution in very relatable ways will always set a great product apart.”
Jane Van Aken, Director of Service Development, Spirit Digital
Readability data has revealed that the average reading age in the UK is that of a nine-year-old (Taylor, 2019). This reinforces the importance of communicating with patients using simple language, especially when introducing them to a new service they feel wary of.
It’s important to remember that a large group of people living in the UK do not speak English as their first language. In 2018, it was found that 770,000 people living in England speak very little or none at all (Asthana, 2018). These patients often rely on bi-lingual family members or support staff at online centres to translate health information. Ensuring high-quality translations are available in online services can make a huge difference
Once you have an easy-to-understand, co-designed piece of tech, we need to make sure patients can connect to it. Health tech organisations, including Spirit Digital, have already started to provide digital devices, including tablets and internet, to individual patients to guarantee them access to online services. Forging partnerships with local authorities, voluntary organisations and private sector is crucial in overcoming data poverty (NHS providers, 2021).
- Supporting healthcare professionals
A big barrier for closing the gap is health and social care professionals lacking the confidence or skills to use digital health tools themselves and thus not recommending the services to their patients (NHS Digital, 2019). The digital inclusion guides for health and social care in England and Wales recommend additional training for staff to improve their digital skills (Aldridge, 2020). Ensuring healthcare workers are confident in their ability to use digital technology and happy to introduce it to patients, brings us one step closer to closing the divide.
- Patient support from peers, professionals, and digital champions
A Lloyds report found that 66% of people would prefer to learn how to use digital tools from friends, family or work colleagues (Weston, 2021). Meanwhile, 67% of people said they would improve their digital skills if they knew support was available when needed (Weston, 2021).
Health organisations should work with patients and their support networks to encourage and help them adopt digital services. Collaborating with carers, teachers, support workers and other professionals who can offer one-on-one support to patients is recommended (NHS providers, 2021).
“Reaching out to users in whatever way we can, whether it is visiting them in their own home, inviting them to join a local workshop or talking on the phone is imperative. We need to find ways to be inclusive and continue to break down the barriers that limit users from accessing digital health solutions.”
Jane Van Aken, Director of Service Development, Spirit Digital
The use of ‘Digital Champions’ has been found useful in various programmes (Aldridge, 2020). According to the NHS, a Digital Champion can be a member of staff of volunteer who provides ongoing digital skills support.
Peer support within digital skill training programmes is highly valuable. Peers who are known and trusted within communities are more likely to provide sustainable support for patients (Richard, 2018). Seeing people succeed with digital technology that patients can relate can help build their confidence and self-belief (Richard, 2018).
The importance of choice
Although, being able to use digital services can help improve people’s lives, it’s important that we offer choice to individuals and respect their decision. If a patient is not willing to use digital technology, they should be offered the same standard of care regardless.
Choice is not only important for people who would rather not go digital, but for those who prefer to use technology in a certain way. A report by Mind found that patients making mental health appointments during the pandemic would have liked to be offered different options for communication i.e telephone call, video call or using a particular platform like Zoom (Mind, 2021). This is a prime example for how catering to patients’ individuals can increase the likelihood of engagement and receive the full benefits from the service.
Undoubtedly, digital health technology is here to stay, and we cannot ignore the role it plays in health equality. As Richards (2021) put it ‘digital health trends are the driving forces behind health equity’.
Looking forward to life beyond COVID-19, it is crucial that we create a variety of digital tools that meet the diverse needs of society, keeping an eye on connectivity, while providing ongoing support for vulnerable patients. One day this will be a long-forgotten issue, but until then we must strive to do everything we can to make sure every member of society has access to all the healthcare services they need.
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Aldridge (2020) Improving Digital Health Inclusion: evidence scan, available at https://www.strategyunitwm.nhs.uk/sites/default/files/2021-04/Digital%20Inclusion%20evidence%20scan.pdf
Asthana (2018) Sajid Javid: 770,000 people in England unable to speak English well, The Guardian, available at https://www.theguardian.com/politics/2018/mar/14/sajid-javid-770000-people-in-england-not-able-to-speak-english
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