The training day provided our first discussion about the nature of digital health technologies and services and the views and experiences of people from different underserved communities with these innovations. Summarising the discussion from meeting notes and posters it is possible to identify three main themes where digital health technologies are seen to have both desirable and undesirable impact on peoples’ life.
The three main themes we can identify are (i) the characteristics of the technology; (ii) the characteristics and lifestyle of users; and (iii) the characteristic of health systems and society
(i) Characteristics of the technologies
Digital health technologies such as smart watches and mobile phones are seen to work well for monitoring several conditions such as diabetes and blood pressure. They are seen to be fast, accurate (in terms of preventing human error though doubts were expressed about the accuracy of some devices) and convenient for many users. The technologies also enable a timely response when health services respond in a prompt manner and make it easier for health professionals to share health information as all information is stored in one place.
A number of concerns were also expressed such as the high costs of these technologies (for example the need to keep the phones in credit or hardware breakdowns); problems of bad or unreliable connectivity which result in loss of data and detail; and the fact that devices required frequent upgrading. Several of the community digital champions also pointed out that the technologies are often too difficult for people suffering from ill health and they are not designed with the needs of older people, those with disabilities or learning difficulties in mind. The discussion also highlighted the dangers of inaccurate self-diagnosis, misdiagnosis, and false alarms. Difficulties are often related to the use of medical language as well as the challenges faced by non-English speakers so a new set of skills and understanding would be required by people to engage with them. There was a strong view that digital health technologies could not replace face to face interactions.
(ii) Characteristics and lifestyle of users
Digital health technologies were seen to work well for people with busy lifestyles because they can save time and allow more flexibility. Monitoring devices can be personalised and be seen as motivational by those who are health conscious and involved in their fitness (for example reminding people that they need to take a walk after a long time sitting down). They can also be used for healthy and fun competition between peers and to encourage self-care and create mindfulness around health.
Several community digital champions however questioned the need for so much monitoring arguing that introducing competitiveness about fitness is not necessarily positive because it can create anxiety if not living up to expectations, demotivating people when they are struggling. For many people (for example people with caring responsibilities who also work long hours) it is difficult or often impossible to meet expectations around self-care. Moreover, people differ in their desire or ability to accept change and the effort required to learn new ways of doing things. The questioned was asked ‘Does all this monitoring actually improve your life?’
(iii) Characteristic of the health system and society
During discussions, several community digital champions pointed out that digital health technologies could be used to help but also harm people. Some champions expressed uneasiness regarding the dangers of abuse of peoples’ data, of hacking and infringements of patient confidentiality. Apprehension was also expressed regarding the potential for surveillance and the idea of ‘big brother is watching’ as well as people being ‘forced into one way of life’ against their wishes. Concern was also expressed that treatment would not be provided for people who didn’t use digital devices so that digital technologies could lead to the exclusion of people from the healthcare system. At a time when many people are already living in digital poverty, there was a danger that many would struggle to access appropriate healthcare. Disquiet was also expressed about GPs losing the personal touch and connections with their patients and how this could also lead to people not going to their GPs “GPs want you to do it yourself, this is now becoming acceptable, but this can also lead to exclusion.
What is needed for digital health technologies to work well for communities
Digital champions also identified some of what was needed for digital health technologies to work in their communities. This included the development of technologies and health services that were tailored to the needs of communities (for example pop-up clinics and community drop-in sessions with health professional). Regular training and upskilling of the digital skills of communities is also necessary. Regular engagement with community organisations and community leaders to identify the needs of communities was also mentioned as well as the need to gain the trust of people from different communities.
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