Can digital health interventions assist with patient support in primary care settings?: Exploring enablers and barriers.

Problem

The use of digital health interventions (DHI), such as apps, websites and wearable devices are becoming more common in health and care services, to help people prevent and manage diabetes and heart disease (cardiometabolic disease). However, there are currently several challenges with DHIs, including cost, accessibility and willingness to use them. We wanted to bring together evidence on how DHIs for cardiometabolic disease are used among South Asian populations, who have a higher risk of these diseases. This can help us understand how to best design DHIs, and introduce and support people to use them, so that they can get the most benefit from them.

Approach

We recruited 45 individuals from a South Asian background with cardiometabolic disease to participate in online or in-person focus groups or interviews, which were audio recorded. The audio recordings were transcribed and coded using reflexive thematic analysis. Findings were categorised using a framework of four potential levels of action for digital health inequalities: individuals, provider or healthcare systems, population or society, and intervention.

Findings

Participants often had varied understanding and awareness of available DHIs. Engagement with the NHS app, remote consultations, self-measurement or monitoring tools and lifestyle management apps have become more common, with the impact of COVID-19 restrictions forcing change or creating new opportunities for digital engagement. Barriers to using DHIs include: general fear of technology; lack of trust in digital tools, such as concerns of being tracked; lack of reliability or accuracy of data; and uncertainty about interpretation of results and whether they were designed for healthcare professionals or patients. Many participants preferred the improved communication in face-to-face consultations with their GPs, but recognised the usefulness and convenience of remote consultation. Digital communication from the providers offered reassurance and reduced patient anxiety. Participants suggested that DHIs should be offered with explanation and support on how to use it; beyond reliance on family members. Healthcare providers and community organisations can play an integral role in providing such services to improve access to DHIs and raise awareness and trust in such tools.

Consequences

Digital health technology can improve patient outcomes, engagement, provide better access to care, and reduce costs to both the patient and provider. Our study suggests that primary healthcare providers should focus on patient education, providing clear and concise information on digital health options to increase uptake and understanding. Our findings additionally suggest that primary healthcare providers should ensure that digital health services are tailored to the needs of marginalised patients and aligned with their preferences.