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Healthcare is becoming increasingly digital, but ensuring people have the digital literacy to use these technologies is a job that will never be fully done, according to a panel of experts.
At the Healthcare Excellence Through Technology (HETT) 2019 conference, Kate Gallant, learning facilitator at One Digital/SCVO; Victoria Betton, managing director of mHabitat; and Anna Osbourne, head of communications and public affairs at the Good Things Foundation, discussed how digital exclusion will lead to people being left out of participating in healthcare as it becomes more digitally driven.
But teaching people to use technology for something as sensitive as healthcare isn’t a project that can ever be called “finished”, according to the panel.
Citing research by the Oxford Institute, Gallant said: “For every year over 50, you are 2% more likely to be digitally excluded. And there is no sign, if you look at that trend, of it going away.”
When building digital healthcare systems, many factors have to be taken into account, including the ageing population and what this means for digital literacy in a time when technology is rapidly growing and changing, as well as the problems causing a lack of digital literacy, or a lack of engagement with technology in the first place.
Why are people digitally excluded?
Around 7.4m people in the UK have no access to the internet, and a large number do not have the digital skills required to complete basic tasks – these are the people who would be quickly left behind if healthcare increases its use of technology for things such as access to patient records, correspondence or appointments.
Many of the people who are digitally excluded are often socially excluded as well, making them more difficult to reach to give them the skills needed.
“The people who are most likely to be offline are likely to be older, have a worse educational background, living in poverty, living in social housing, or be earning less money than the average. When we’re talking about issues of health, that’s obviously a huge issue,” said Good Things Foundation’s Osbourne.
As mHabitat’s Betton put it, those who will end up relying on the NHS the most may also end up being the most left behind as healthcare moves in a more digital direction.
In some cases, there may be several barriers preventing someone from taking part in digital services.
“Working with an ethnic minority group, you often have multiple barriers for people in those groups,” said Gallant. “So you’ll have a language barrier as well as a digital skills barriers, so it’s about working out how we can work most effectively with that group to build their competency and capability in both areas at the same time.”
On the other hand, there are people who have some level of digital capability, but not enough to participate in digital health services, or they don’t see the need to use technology in this way.
Gallant said while some may have a smartphone, they may not know how to use it or could not use it to log in to health services.
There may also be patients who have a “proxy user” who helps them to use digital technology when necessary, so they wouldn’t feel comfortable using it on their own.
Creating pathways into digital literacy for just these people won’t cut it though – the panel pointed out that it’s not just the usual suspects who reject the use of digital systems as part of their NHS care.
“Digital literacy is influenced by a whole range of socio demographic factors of which age is one, but also people’s education levels, the degree on which they live in poverty can be influencing factors,” said Betton.
While people assume young people may not fall into the digitally illiterate category, Betton said young people aren’t “somehow magic”, and while they are adept at using technology, it doesn’t always mean they can or will use digital services to manage their relationship with the NHS.
Betton also claimed a number of other factors, such as “trust, motivation, confidence and self-efficacy”, play a huge part in whether or not people choose to engage in a technology.
If people stop being motivated, they stop using the service – this could come at the hands of an update they don’t understand, or a bad user experience, as well as a whole host of other factors that need to be considered when developing both digital services and training.
“Motivation is the biggest thing that’s keeping people offline, because they just can’t see why it’s relevant for them,” said Osbourne.
“They don’t know about what’s available to them, or they’re quite happy in their lives not using technology. And that’s why digital inclusion really is such a complex issue, because overcoming that kind of quite personal barrier of not seeing what’s in it for them is quite challenging.”
Engaging people through co-design
NHSX, the new digital arm of the NHS, was launched in 2019 to outline the ways healthcare across the UK can be more digital, with the aim of using technology to make the lives of patients and practitioners easier.
This will mean a level of digital literacy will be needed by all of those involved, and the technology offered will have to be easy for everyone’s use to save both time and – in some cases – lives.
Betton said that sometimes firms or public services opt to develop digital tools for those who are confident using digital and allow them to “self-service”, with the view that this leaves more time and resource for face-to-face tuition of those who aren’t as confident using digital.
But she pointed out this doesn’t necessarily mean the digitally literate will use these services – when it comes to making digital services, one way to ensure motivation and engagement is to make sure the community is involved in the development of the services, according to the panel.
Gallant said: “If you’re thinking about developing a digital service, co-design from the start is really important. So not, ‘I’ve developed my product and I want to test it’, but, ‘This is a product that we need and would be useful to patients, let’s talk to them about it and start to engage them’.”
She added that while guidelines for co-designing digital services exist, such as those provided by charity CAST, security and accessibility should be built into any services from the beginning to address issues of trust, and to ensure services are designed for everyone’s use from the start.
On the topic of developing education programmes to help people build the digital literacy needed to participate in online or mobile healthcare services, the panel advised that those offering education need to think about the audience they are trying to reach, as this can address both a lack of ability and motivation.
Osbourne said that understanding what support the audience of digital literacy education needs is “crucial” and should be followed up with local partners to develop a service that works in that particular community.
For some who may already have access to technology and know how to use it, but still not want to use digital healthcare services, Gallant said you have to find a “hook” – a way in that will make the technology useful and relevant to them.
Words of warning
The panel warned against making assumptions when developing digital services and ways to educate people about how to use them.
“The top tip is always to not make assumptions, even about young people – just because they may be able to send a message through WhatsApp or post something on Instagram, don’t assume that they’ll be able to access a service online,” said Gallant.
The panel also emphasised the importance of thinking about local communities when developing learning tools or services.
“Not everyone will want to go to a library to do the learning,” said Osbourne. “Some people want to learn in their own home using online resources, some people need that one-to-one support. So as a tip for people in the room who are looking to do this, it’s really important to understand your audience.”
While there is a lot to take into consideration when trying to develop a digital NHS, what is clear is just developing services is not enough – ensuring they are relevant and accessible, as well as giving those without access the tools and skills needed to use them is becoming increasingly important.
“We’re really at crunch point,” said Osbourne. “If we don’t tackle this now, the people who are being left behind are going to be pushed even further behind.”