How Do We Better Serve Excluded Populations When Delivering Digital Health Technology? Inclusion Evaluation of a Digital Musculoskeletal Self-Management Solution.
information technology
musculoskeletal
self‐management
Journal
Musculoskeletal care
ISSN: 1557-0681
Titre abrégé: Musculoskeletal Care
Pays: England
ID NLM: 101181344
Informations de publication
Date de publication:
Sep 2024
Sep 2024
Historique:
revised:
12
07
2024
received:
18
06
2024
accepted:
22
07
2024
medline:
24
8
2024
pubmed:
24
8
2024
entrez:
24
8
2024
Statut:
ppublish
Résumé
Digital self-management platforms have been proposed as a solution to better support people manage their musculoskeletal (MSK) condition. However, research studies often explicitly exclude people who can't access internet connected devices. An important consideration is that digital exclusion (for people without access to an internet connected device) from these new digital options will worsen already existing inequality and inequity in healthcare. To evaluate the acceptability and potential causes of digital exclusion of the South West London (SWL) MSK self-management app. (1) Explore why some patients are not using the app and any barriers they have. Explore why some clinicians are not prescribing the app. (2) Make recommendations, based on these findings, to improve digital inclusion. An explanatory sequential mixed method service evaluation that consisted of initial questionnaires to identify suitable collaborators, followed by structured interviews of patients and clinicians. Following a comprehensive data analysis, 10 sub-themes were grouped into four main themes: (1) Beliefs: Importance of understanding the role of digital; face to face consultation is still valued and needed. (2) Barriers: Lack of digital literacy; lack of physical examination/contact with a clinician. (3) Enablers: Immediate access to advice and information; perceived better control over health; ease of use; no appointment needed. (4) Solutions: Support and training; greater awareness. As digital health technology develops, strategies must change, requiring deliberate work and investments to improve inclusion. Our findings highlight how digital technology design and delivery can be adapted to address the causes of digital exclusion.
Sections du résumé
BACKGROUND
BACKGROUND
Digital self-management platforms have been proposed as a solution to better support people manage their musculoskeletal (MSK) condition. However, research studies often explicitly exclude people who can't access internet connected devices. An important consideration is that digital exclusion (for people without access to an internet connected device) from these new digital options will worsen already existing inequality and inequity in healthcare.
AIM
OBJECTIVE
To evaluate the acceptability and potential causes of digital exclusion of the South West London (SWL) MSK self-management app.
OBJECTIVES
OBJECTIVE
(1) Explore why some patients are not using the app and any barriers they have. Explore why some clinicians are not prescribing the app. (2) Make recommendations, based on these findings, to improve digital inclusion.
METHODS/DESIGN
METHODS
An explanatory sequential mixed method service evaluation that consisted of initial questionnaires to identify suitable collaborators, followed by structured interviews of patients and clinicians.
RESULTS
RESULTS
Following a comprehensive data analysis, 10 sub-themes were grouped into four main themes: (1) Beliefs: Importance of understanding the role of digital; face to face consultation is still valued and needed. (2) Barriers: Lack of digital literacy; lack of physical examination/contact with a clinician. (3) Enablers: Immediate access to advice and information; perceived better control over health; ease of use; no appointment needed. (4) Solutions: Support and training; greater awareness.
CONCLUSIONS
CONCLUSIONS
As digital health technology develops, strategies must change, requiring deliberate work and investments to improve inclusion. Our findings highlight how digital technology design and delivery can be adapted to address the causes of digital exclusion.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1925Subventions
Organisme : NHS England
Informations de copyright
© 2024 John Wiley & Sons Ltd.
Références
Abimbola, S., S. Keelan, M. Everett, et al. 2019. “The Medium, the Message and the Measure: A Theory‐Driven Review on the Value of Telehealth as a Patient‐Facing Digital Health Innovation.” Health Economics Review 9, no. 1: 21. https://doi.org/10.1186/s13561‐019‐0239‐5.
Ackerman, I. N., A. Bucknill, R. S. Page, et al. 2017. “Preferences for Disease‐Related Education and Support Among Younger People With Hip or Knee Osteoarthritis.” Arthritis Care & Research 69, no. 4: 499–508. https://doi.org/10.1002/acr.22950.
Anjum, R. L., S. Copeland, and E. Rocca, eds. 2020. Rethinking Causality, Complexity and Evidence for the Unique Patient. A CauseHealth Resource for Healthcare Professionals and the Clinical Encounter. Cham: Springer. https://doi.org/10.1007/978-3-030-41239-5.
Atkins, L., J. Francis, R. Islam, et al. 2017. “A Guide to Using the Theoretical Domains Framework of Behaviour Change to Investigate Implementation Problems.” Implementation Science 12, no. 1: 77. https://doi.org/10.1186/s13012‐017‐0605‐9.
Babatunde, O. O., J. L. Jordan, D. A. Van Der Windt, J. C. Hill, N. E. Foster, and J. Protheroe. 2017. “Effective Treatment Options for Musculoskeletal Pain in Primary Care: A Systematic Overview of Current Evidence.” PLoS One 12, no. 6: e0178621. https://doi.org/10.1371/journal.pone.0178621.
Barber, T., B. Sharif, S. Teare, et al. 2019. “Qualitative Study to Elicit Patients’ and Primary Care Physicians’ Perspectives on the Use of a Self‐Management Mobile Health Application for Knee Osteoarthritis.” BMJ Open 9, no. 1: e024016. https://doi.org/10.1136/bmjopen‐2018‐024016.
Berry, A., C. McClellan, B. Wanless, and N. Walsh. 2022. “A Tailored App for the Self‐Management of Musculoskeletal Conditions: Evidencing a Logic Model of Behavior Change.” JMIR Formative Research 6, no. 3: e32669. https://doi.org/10.2196/32669.
Biebl, J. T., S. Huber, M. Rykala, E. Kraft, and A. Lorenz. 2020. “Attitudes and Expectations of Health Care Professionals Toward App‐Based Therapy in Patients With Osteoarthritis of the Hip or Knee: Questionnaire Study.” JMIR MHealth and UHealth 8, no. 10: e21704. https://doi.org/10.2196/21704.
Braun, V., and V. Clarke. 2006. “Using Thematic Analysis in Psychology.” Qualitative Research in Psychology 3, no. 2: 77–101. https://doi.org/10.1191/1478088706qp063oa.
Button, K., K. Nicholas, M. Busse, M. Collins, and I. Spasić. 2018. “Integrating Self‐Management Support for Knee Injuries Into Routine Clinical Practice: TRAK Intervention Design and Delivery.” Musculoskeletal Science and Practice 33: 53–60. https://doi.org/10.1016/j.msksp.2017.11.002.
Clarkson, P., I. Vassilev, A. Rogers, et al. 2020. “Integrating a Web‐Based Self‐Management Tool (Managing Joint Pain on the Web and Through Resources) for People With Osteoarthritis‐Related Joint Pain With a Web‐Based Social Network Support Tool (Generating Engagement in Network Involvement): Design, Development, and Early Evaluation.” JMIR Formative Research 4, no. 11: e18565. https://doi.org/10.2196/18565.
De Oliveira Silva, D., M. F. Pazzinatto, K. M. Crossley, F. M. Azevedo, and C. J. Barton. 2020. “Novel Stepped Care Approach to Provide Education and Exercise Therapy for Patellofemoral Pain: Feasibility Study.” Journal of Medical Internet Research 22, no. 7: e18584. https://doi.org/10.2196/18584.
de Vries, H. J., C. J. J. Kloek, D. H. de Bakker, J. Dekker, D. Bossen, and C. Veenhof. 2017. “Determinants of Adherence to the Online Component of a Blended Intervention for Patients With Hip and/or Knee Osteoarthritis: A Mixed Methods Study Embedded in the e‐Exercise Trial.” Telemedicine and E‐Health 23, no. 12: 1002–1010. https://doi.org/10.1089/tmj.2016.0264.
Ekman, B., H. Nero, L. S. Lohmander, and L. E. Dahlberg. 2020. “Costing Analysis of a Digital First‐Line Treatment Platform for Patients With Knee and Hip Osteoarthritis in Sweden.” PLoS One 15, no. 8: e0236342. https://doi.org/10.1371/journal.pone.0236342.
Francis, J. J., M. Johnston, C. Robertson, et al. 2010. “What Is an Adequate Sample Size? Operationalising Data Saturation for Theory‐Based Interview Studies.” Psychology and Health 25, no. 10: 1229–1245. https://doi.org/10.1080/08870440903194015.
Health Education England. 2024. “Advanced Practice MSK Curriculum and Capabilities Framework.” London, UK. Unpublished Final Draft.
Health Innovation Network. 2022. A Co‐Designed Approach to Scoping and Evaluating the Digital Health Technology getUBetter. https://healthinnovationnetwork.com/report/a‐co‐designed‐approach‐to‐scoping‐and‐evaluating‐the‐digital‐health‐technology‐getubetter/.
Hewitt, S., R. Sephton, and G. Yeowell. 2020. “The Effectiveness of Digital Health Interventions in the Management of Musculoskeletal Conditions: Systematic Literature Review.” Journal of Medical Internet Research 22, no. 6: e15617. https://doi.org/10.2196/15617.
Hunter, R., M. Beattie, C. O’Malley, and T. Gorely. 2023. “Mobile Apps to Self‐Manage Chronic Low Back Pain: A Realist Synthesis Exploring What Works, for Whom and in What Circumstances.” PEC Innovation 3: 100175. https://doi.org/10.1016/j.pecinn.2023.100175.
Institute for Health Metrics and Evaluation (IHME). 2020. GBD Results. Seattle, WA: IHME, University of Washington. https://vizhub.healthdata.org/gbd‐results/.
Kelly, M., B. Fullen, D. Martin, S. McMahon, and J. G. McVeigh. 2021. “eHealth Interventions to Support Self‐Management in People With Musculoskeletal Disorders: A Scoping Review Protocol.” JBI Evidence Synthesis 19, no. 3: 709–720. https://doi.org/10.11124/JBIES‐20‐00147.
Kloek, C. J. J., J. M. van Dongen, D. H. de Bakker, D. Bossen, J. Dekker, and C. Veenhof. 2018. “Cost‐Effectiveness of a Blended Physiotherapy Intervention Compared to Usual Physiotherapy in Patients With Hip and/or Knee Osteoarthritis: A Cluster Randomized Controlled Trial.” BMC Public Health 18, no. 1: 1082. https://doi.org/10.1186/s12889‐018‐5975‐7.
London Office of Technology and Innovation (LOTI). 2022. Mapping Digital Exclusion in London. A Toolkit for London boroughs. LOTI Toolkit. https://docs.google.com/document/d/1GSByTNfYJ_ACIkTwSHBiNN2cn0PqszElJ4bL‐3oB5Vc/edit.
Michie, S., L. Atkins, and R. West. 2014. The Behaviour Change Wheel: A Guide to Designing Interventions. London, UK: Silverback Publishing. https://www.behaviourchangewheel.com.
Mistry, P., and J. Jabbal. 2023. Moving From Exclusion to Inclusion in Digital Health and Care. https://www.kingsfund.org.uk/publications/exclusion‐inclusion‐digital‐health‐care.
Murray, E., H. Jarman, and B. Wanless. 2021. GetUBetter – How We Can Implement a Digital Self‐Management Tool Into a Busy Emergency Department for Patients With Back Pain. https://healthinnovationnetwork.com/insight/implement‐a‐digital‐self‐management‐tool‐into‐a‐busy‐emergency‐department‐for‐patients‐with‐back‐pain/.
National Institute for Health and Care Excellence. 2022. “Osteoarthritis in Over 16s: Diagnosis and Management.” [NG226]. https://www.nice.org.uk/guidance/ng226.
National Institute for Care and Excellence. 2017. “Low Back Pain and Sciatica in Over 16s: Assessment and Management NICE Guideline [NG59].” NICE 63, no. 2: 120. https://doi.org/10.1016/j.jphys.2017.02.012.
National Voices. 2014. “Supporting Self‐Management. A Summary of the Evidence. Key Themes From 228 Systematic Reviews.” National Voices. https://www.nationalvoices.org.uk/publications/our‐publications/supporting‐self‐management.
NHS England. 2019. The NHS Long Term Plan. https://www.longtermplan.nhs.uk/.
Nicholl, B. I., L. F. Sandal, M. J. Stochkendahl, et al. 2017. “Digital Support Interventions for the Self‐Management of Low Back Pain: A Systematic Review.” Journal of Medical Internet Research 19, no. 5: 1–21. https://doi.org/10.2196/JMIR.7290.
O’Connor, S., P. Hanlon, C. A. O’Donnell, S. Garcia, J. Glanville, and F. S. Mair. 2016. “Understanding Factors Affecting Patient and Public Engagement and Recruitment to Digital Health Interventions: A Systematic Review of Qualitative Studies.” BMC Medical Informatics and Decision Making 16, no. 1: 120. https://doi.org/10.1186/s12911‐016‐0359‐3.
Ofcom. 2020. Use of Communication Services, Consumer Omnibus: Digital Exclusion Analysis. https://www.ofcom.org.uk/__data/assets/excel_doc/0031/195358/use‐of‐communication‐services‐consumer‐omnibus‐digital‐exclusion‐analysis.xlsx.
Ofcom. 2022. Online Nation 2022 Report. https://www.ofcom.org.uk/__data/assets/pdf_file/0023/238361/online‐nation‐2022‐report.pdf.
Office for National Statistics. 2022. Sickness Absence in the UK Labour Market. https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/datasets/sicknessabsenceinthelabourmarket.
Perski, O., and C. E. Short. 2021. “Acceptability of Digital Health Interventions: Embracing the Complexity.” Translational Behavioral Medicine 11, no. 7: 1473–1480. https://doi.org/10.1093/tbm/ibab048.
Public Health England. 2019. Musculoskeletal Health: A 5 Year Strategic Framework for Prevention Across the Lifecourse Department of Health and Social Care Working With Public Health England and Department for Work and Pensions. PHE Publications Gateway. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/810348/Musculoskeletal_Health_5_year_strategy.pdf.
Ray, A., A. Stevens, and A. Thirunavukarasu. 2020. Offline and Left Behind: How Digital Exclusion Has Impacted Health During the COVID‐19 Pandemic. https://blogs.bmj.com/bmj/2020/07/03/offline‐and‐left‐behind‐how‐digital‐exclusion‐has‐impacted‐health‐during‐the‐covid‐19‐pandemic/.
Razai, M. S., P. Oakeshott, H. Kankam, S. Galea, and H. Stokes‐Lampard. 2020. “Mitigating the Psychological Effects of Social Isolation During the COVID‐19 Pandemic.” BMJ 369: m1904. https://doi.org/10.1136/bmj.m1904.
Sapolsky, R. M. 2017. Behave: The Biology of Humans at Our Best and Worst. New York: Penguin Press.
Sekhon, M., M. Cartwright, and J. J. Francis. 2017. “Acceptability of Healthcare Interventions: An Overview of Reviews and Development of a Theoretical Framework.” BMC Health Services Research 17, no. 1: 88. https://doi.org/10.1186/s12913‐017‐2031‐8.
Stone, E., P. Nuckley, and R. Shapiro. 2020. Digital Inclusion in Health and Care: Lessons Learned From the NHS Widening Digital Participation Programme (2017–2020). https://www.goodthingsfoundation.org/insights/digital‐participation‐lessons‐learned/.
The Good Things Foundation. 2016. Health & Digital: Reducing Inequalities, Improving Society an Evaluation of the Widening Digital Participation Programme. https://www.goodthingsfoundation.org/wp‐content/uploads/2016/07/Health‐and‐Digital‐2016.pdf.
Tieu, L., U. Sarkar, D. Schillinger, et al. 2015. “Barriers and Facilitators to Online Portal Use Among Patients and Caregivers in a Safety Net Health Care System: A Qualitative Study.” Journal of Medical Internet Research 17, no. 12: e275. https://doi.org/10.2196/jmir.4847.
Turnbull, S., C. Cabral, A. Hay, and P. J. Lucas. 2020. “Health Equity in the Effectiveness of Web‐Based Health Interventions for the Self‐Care of People With Chronic Health Conditions: Systematic Review.” Journal of Medical Internet Research 22, no. 6: e17849. https://doi.org/10.2196/17849.
Versus Arthritis. 2021. The State of Musculoskeletal Health 2021: Arthritis and Other Musculoskeletal Conditions in Numbers. https://www.versusarthritis.org/media/24238/state‐of‐msk‐health‐2021.pdf.
Wanless, B., and C. McClellan. 2019. “Delivering Self‐Management for LBP via a Digital Solution in Primary Care – A Sustainable Solution for a Growing Problem.” Physiotherapy 105: e140–e141. https://doi.org/10.1016/j.physio.2018.11.134.
Wanless, B., C. Sothinathan, H. Oakley, A. Berry, and T. Noblet. 2022. Ben Wanless, Christina Sothinathan, Helen Oakley, Tim Noblet. Digital Self‐Management of Musculoskeletal (MSK) Conditions. Protocol for a Mixed Methods Systematic Review. PROSPERO 2022 CRD42022346736. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022346736.
Wilson, S., C. Tolley, R. Mc Ardle, et al. 2024. “Recommendations to Advance Digital Health Equity: A Systematic Review of Qualitative Studies.” Npj Digital Medicine 7, no. 1: 173. https://doi.org/10.1038/s41746‐024‐01177‐7.