A study entitled ‘Quantifying digital health inequality across a national healthcare system’ has been published in Research Square, setting out how the researchers analysed data from 6,356 primary care providers across England to test the association between population characteristics and digital uptake.
“Quantifying sociodemographic inequalities within digital health uptake is critical for developing effective policy interventions,” the study states. Noting that the NHS App and primary care service portals are the result of recent digital transformation within the NHS, the researchers used electronic practice-level metadata recording usage of these systems to assess population uptake, and to examine the sociodemographic characteristics associated with reduced uptake.
The researchers analysed 12 months of metadata up to October 2022 from the providers, and found that by the end of this period, more than 37 million patients were activated on the NHS App (67.9 percent of the population), with more than 34 million patients (61.9 percent of the population) activated for online primary care services.
With regards to sociodemographic characteristics, the researchers compared uptake against a number of factors including a standardised index of deprivation covering income, employment, education, health, crime, housing and the local environment. Other factors included age, ethnicity, diagnosis of mental health disorder or long-term conditions, number of prescription items per patient, and level of urbanity.
Looking firstly at the NHS App, the study found that increased population from the two most socioeconomically deprived quintiles was associated with reduced activation of the app, with the least deprived quintile associated with greater app uptake. Age was another factor affecting uptake, with the 76-85 age group at a lower level of uptake, as was the level of urbanity. The researchers found varying association with long-term conditions, with heart failure and chronic pulmonary disorder patients associated with increased uptake, but dementia and mental health patients associated with reduced uptake.
Similar results were found for the online primary care services, with the most deprived areas less likely to use the services and similar associations for age, urbanity and chronic disease.
Black and Asian populations showed negative association with digital uptake in both outcomes, the researchers said, but not at a significant level.
“Our results confirm relationships between population sociodemographic factors and digital health uptake, with consistent results across two general (i.e. not disease specific) patient-facing interventions with availability to a national population,” the researchers state. “Deprivation is a stand-out factor in our analyses, supported by studies of general technology uptake in the UK population, and existing understanding of underlying factors for digital literacy.”
They added that policy approaches to promoting equitable healthcare will need to be based on an understanding of the obstacles to uptake with regards to different demographics, with infrastructure, education and targeted engagement as the “obvious keys to unlocking the gateway of equitable provision”.
The study was undertaken by Joe Zhang, Jack Gallifant, Robin Pierce, James Teo, Leo Celi and Hutan Ashrafian and can be accessed here.
