Throughout the pandemic, we have seen a rapid increase in the use of digital technology to deliver healthcare.
Digital technology has been integrated into national and regional public plans to deliver critical health messages and contract tracing, for example. And digital tools have enabled a continuation of care through remote services, such as virtual appointments. But while our healthcare system is slowly adapting to these digital strategies, there are concerns that parts of our population are being left behind. Not everyone has access to a stable internet connection, smartphones or laptops. And some groups, such as older people, lack the skills and confidence to use digital resources and are unsure of what information they should trust.
To find out more, we spoke to IGHI’s Viknesh Sounderajah, clinical research fellow and Dr Jonathan Clarke, Sir Henry Wellcome postdoctoral fellow, about their recent study to assess public readiness for digital health strategies against COVID-19 in the UK.
How effective have digital strategies been in the UK’s response to COVID-19?
Examples such as the NHS Test and Trace mobile app and online medical consultations demonstrate that there is capability to rapidly deliver digital programmes at scale. Yet there is limited data regarding their uptake within marginalised and at-risk communities, such as ethnic minorities. It’s therefore difficult to determine the overall effectiveness of these programmes without first understanding the effects that they have had on groups who are also vulnerable to the coronavirus. In fact, this was the reason we wanted to conduct this very study!
Tell us about your recent study.
We surveyed the opinions of over 2,000 people across the UK to assess how ready they are for the digital health strategies used as part of the COVID-19 response. We found that those who were older, more deprived and less educated were all less likely to effectively engage with COVID-19-specific digital health technologies.
Importantly, we found that the UK population vary in where they look for healthcare information, how much they trust information and how comfortable they are at engaging with remotely delivered healthcare. Our study suggests that current digital public health approaches to COVID-19 have the potential to marginalise groups who are at risk of digital exclusion and poor health outcomes from the coronavirus. Thus, potentially widening the digital divide and further driving inequality in health and care.
How does a digital divide create inequality in healthcare?
Over the course of the COVID-19 pandemic, there has been greater emphasis on providing healthcare support through digital means, whether it be through video consultation, e-mail or through mobile apps. Therefore, those who do not have full access to digital technologies, or feel comfortable using them, may also struggle to access the care they need. Also, they may fall behind on real-time alerts (such as those regarding local quarantine measures or vaccination appointments) that would ultimately impact their health.
As digital technologies in care delivery become the norm, there is a risk that more traditional means of interaction between patients and the health service, such as face-to-face appointments, may no longer be supported. Those who are less able to engage with digital services may miss out and receive an inferior service as a result.
What can be done to ensure everybody has equal access to digital health services?
The main barriers to digital inclusion include a desire to engage in digital strategies, feeling capable to use digital platforms, and access to the hardware, affordable internet and mobile phone data to do so. Through our study, we emphasise that there is unlikely to be a ‘one-size-fits-all’ approach that ensures equal access to digital health services. As such, overcoming each of these barriers requires a multifaceted approach through government, education services and community input, among other stakeholders. In the meantime, it is essential that non-digital options, such as telephone services and staffed public access points, remain open to ensure that nobody gets left behind.
Read the paper, ‘A national survey assessing public readiness for digital health strategies against COVID-19 within the United Kingdom’ here, by Viknesh Sounderajah, Jonathan Clarke, Seema Yalamanchili, Amish Acharya, Sheraz R. Markar, Hutan Ashrafian and Ara Darzi. Published in Nature journal.