1
|
Turnbull S, Cabral C. Inequalities in the Ability for People With Type 2 Diabetes and Prediabetes to Adapt to the Reduction in In-Person Health Support and Increased Use of Digital Support During the COVID-19 Pandemic and Beyond: Qualitative Study. JMIR Diabetes 2024; 9:e55201. [PMID: 38917452 DOI: 10.2196/55201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/23/2024] [Accepted: 05/09/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic created unprecedented challenges for people with type 2 diabetes (T2D) and prediabetes to access in-person health care support. Primary care teams accelerated plans to implement digital health technologies (DHTs), such as remote consultations and digital self-management. There is limited evidence about whether there were inequalities in how people with T2D and prediabetes adjusted to these changes. OBJECTIVE This study aimed to explore how people with T2D and prediabetes adapted to the reduction in in-person health support and the increased provision of support through DHTs during the COVID-19 pandemic and beyond. METHODS A purposive sample of people with T2D and prediabetes was recruited by text message from primary care practices that served low-income areas. Semistructured interviews were conducted by phone or video call, and data were analyzed thematically using a hybrid inductive and deductive approach. RESULTS A diverse sample of 30 participants was interviewed. There was a feeling that primary care had become harder to access. Participants responded to the challenge of accessing support by rationing or delaying seeking support or by proactively requesting appointments. Barriers to accessing health care support were associated with issues with using the total triage system, a passive interaction style with health care services, or being diagnosed with prediabetes at the beginning of the pandemic. Some participants were able to adapt to the increased delivery of support through DHTs. Others had lower capacity to use DHTs, which was caused by lower digital skills, fewer financial resources, and a lack of support to use the tools. CONCLUSIONS Inequalities in motivation, opportunity, and capacity to engage in health services and DHTs lead to unequal possibilities for people with T2D and prediabetes to self-care and receive care during the COVID-19 pandemic. These issues can be addressed by proactive arrangement of regular checkups by primary care services and improving capacity for people with lower digital skills to engage with DHTs.
Collapse
Affiliation(s)
- Sophie Turnbull
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Christie Cabral
- Centre for Academic Primary Care, Bristol Medical School, Population Health sciences, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
2
|
Turnbull SL, Dack C, Lei J, Aksu I, Grant S, Lasseter G, Silarova B, Ainsworth B. Barriers and facilitators to use of digital health tools by healthcare practitioners and their patients, before and during the COVID-19 pandemic: a multimethods study. BMJ Open 2024; 14:e080055. [PMID: 38448080 PMCID: PMC10916085 DOI: 10.1136/bmjopen-2023-080055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/21/2023] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES To explore how healthcare practitioners (HCPs) made decisions about the implementation of digital health technologies (DHTs) in their clinical practice before and during the COVID-19 pandemic. DESIGN A multimethods study, comprising semistructured interviews conducted prior to the COVID-19 pandemic, supplemented with an online survey that was conducted during the pandemic with a different sample, to ensure the qualitative findings remained relevant within the rapidly changing healthcare context. Participants were recruited through HCP networks, snowballing and social media. Data were analysed thematically. SETTING Phone interviews and online survey. PARTICIPANTS HCPs represented a range of professions from primary and secondary care across England, with varied socioeconomic deprivation. RESULTS 24 HCPs were interviewed, and 16 HCPs responded to the survey. In the interviews, HCPs described three levels where decisions were made, which determined who would have access to what DHTs: health organisation, HCP and patient levels. These decisions resulted in the unequal implementation of DHTs across health services, created barriers for HCPs using DHTs in their practice and influenced HCPs' decisions on which patients to supply DHTs with. In the survey, HCPs described being provided support to overcome some of the barriers at the organisation and HCP level during the pandemic. However, they cited similar concerns to pre-pandemic about barriers patients faced using DHTs (eg, digital literacy). In the absence of centralised guidance on how to manage these barriers, health services made their own decisions about how to adapt their services for those who struggled with DHTs. CONCLUSIONS Decision-making at the health organisation, HCP and patient levels influences inequalities in access to DHTs for HCPs and patients. The mobilisation of centralised information and resources during the pandemic can be viewed as good practice for reducing barriers to use of DHTs for HCPs. However, attention must also be paid to reducing barriers to accessing DHTs for patients.
Collapse
Affiliation(s)
| | | | | | - Irem Aksu
- Department of Psychology, City University of London, London, UK
| | | | | | - Barbora Silarova
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | | |
Collapse
|
3
|
Farre A, Fang M, Hannah B, Makita M, McFadden A, Menezes D, Rodriguez A, Sixsmith J, M Gray N. Exploring the use of digital technology to deliver healthcare services with explicit consideration of health inequalities in UK settings: A scoping review. Digit Health 2023; 9:20552076231185442. [PMID: 37426580 PMCID: PMC10328001 DOI: 10.1177/20552076231185442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/14/2023] [Indexed: 07/11/2023] Open
Abstract
Objective To map and explore existing evidence on the use of digital technology to deliver healthcare services with explicit consideration of health inequalities in UK settings. Methods We searched six bibliographic databases, and the National Health Service (NHS) websites of each UK nation (England, Scotland, Wales, Northern Ireland). Restrictions were applied on publication date (2013-2021) and publication language (English). Records were independently screened against eligibility criteria by pairs of reviewers from the team. Articles reporting relevant qualitative and/or quantitative research were included. Data were synthesised narratively. Results Eleven articles, reporting data from nine interventions, were included. Articles reported findings from quantitative (n = 5), qualitative (n = 5), and mixed-methods (n = 1) studies. Study settings were mainly community based, with only one hospital based. Two interventions targeted service users, and seven interventions targeted healthcare providers. Two studies were explicitly and directly aimed at (and designed for) addressing health inequalities, with the remaining studies addressing them indirectly (e.g. study population can be classed as disadvantaged). Seven articles reported data on implementation outcomes (acceptability, appropriateness, and feasibility) and four articles reported data on effectiveness outcomes, with only one intervention demonstrating cost-effectiveness. Conclusions It is not yet clear if digital health interventions/services in the UK work for those most at risk of health inequalities. The current evidence base is significantly underdeveloped, and research/intervention efforts have been largely driven by healthcare provider/system needs, rather than those of service users. Digital health interventions can help address health inequalities, but a range of barriers persist, alongside a potential for exacerbation of health inequalities.
Collapse
Affiliation(s)
- Albert Farre
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Mei Fang
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Beth Hannah
- School of Humanities, Social Sciences and Law, University of Dundee, Dundee, UK
| | - Meiko Makita
- School of Health Sciences, University of Dundee, Dundee, UK
| | | | | | | | | | - Nicola M Gray
- School of Health Sciences, University of Dundee, Dundee, UK
| |
Collapse
|
4
|
Borda M, Grishchenko N, Kowalczyk-Rólczyńska P. Patient Readiness for Remote Healthcare Services in the Context of the COVID-19 Pandemic: Evidence From European Countries. Front Public Health 2022; 10:846641. [PMID: 35372199 PMCID: PMC8964525 DOI: 10.3389/fpubh.2022.846641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Despite the fact that remote services were successfully implemented in most European social and health systems before 2020, the COVID-19 pandemic has led to an unprecedented development of health and social care services provided in this form. This paper compares the readiness of patients to use the digital solutions in healthcare systems implemented in EU countries, in response to the current pandemic situation. In the study, technological, health insurance, and demographic variables were selected on the basis of substantive criteria. Next, the linear ordering method was applied to make a ranking of the analyzed countries according to the level of patients' readiness to use digital healthcare services. The main findings show that the Netherlands and Ireland are characterized by the highest level of patients' readiness for using remote healthcare services. On the other hand, Romania and Bulgaria are among the countries with the lowest readiness. The study also made it possible to group European countries according to the level of patients' preparedness.
Collapse
Affiliation(s)
- Marta Borda
- Department of Insurance, Wroclaw University of Economics and Business, Wroclaw, Poland
| | - Natalia Grishchenko
- Institute of Social Policy, National Research University Higher School of Economics, Moscow, Russia
| | | |
Collapse
|
5
|
Öeren M, Jordan I, Coughlin D, Turnbull S. Improving Access to Behavioral Strategies to Improve Mental Well-being With an Entertaining Breakfast Show App: Feasibility Evaluation Study. JMIR Form Res 2022; 6:e25715. [PMID: 35319468 PMCID: PMC8987957 DOI: 10.2196/25715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/03/2021] [Accepted: 01/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background Although mental ill-health is more prevalent among people from lower socioeconomic groups, digital mental well-being innovations are often developed for people from higher socioeconomic groups, who already have resources to maintain good mental and physical health. To decrease health inequalities and ensure that available solutions are appealing and accessible to people with fewer resources, new approaches should be explored. We developed the app Wakey!, which focused on creating engaging mental health content that is accessible, particularly among lower socioeconomic groups in the United Kingdom. Objective The aim of this study is to assess engagement with the app, investigate initial effectiveness data for 6 well-being outcomes, and explore participants’ subjective experiences of using Wakey! Methods The app Wakey! was publicly launched on January 20, 2020, and was free to download from Apple Store and Google Play. The app provided its users with entertaining and educational content related to mental well-being. Concurrently, a single-arm mixed methods feasibility trial was carried out from January to April 2020 among people who had downloaded the app and created an account. The primary outcome was engagement, which was collected passively from data logs. Secondary outcome measures were 6 well-being outcomes collected from self-report questionnaires. Individual interviews with 19 app users were carried out in April 2020. Results In total, 5413 people fit the inclusion criteria and were included in the final sample—65.62% (3520/5364) women, 61.07% (3286/5381) aged between 25 and 44 years, 61.61% (2902/4710) in employment, 8.92% (420/4710) belonging to the lower socioeconomic group, and 8.09% (438/5413) were engaged users. There was no evidence of a difference in engagement regarding sociodemographic and socioeconomic characteristics. There was evidence that users with a higher average daily sleep score, who joined the study more recently, who had higher baseline self-report of sleep quality, and who found episodes more entertaining were more likely to be engaged users. Among 230 users who provided follow-up data, there was evidence of improvements on four of the six well-being outcomes: life satisfaction (P<.001), feeling that life is worthwhile (P=.01), ease of getting up in the morning (P<.001), and self-efficacy (P=.04). The app and its content were well received by those who were interviewed, and several people perceived a positive change in their mental well-being. Conclusions This study shows that the app Wakey! could potentially be engaging across different socioeconomic groups, and there is an indication that it could positively impact the mental well-being of those engaged with the app. However, this study was a pragmatic trial with a limited sample, and the selection bias was present in the qualitative and quantitative study. Further work is needed to make any generalizable conclusions. Trial Registration ClinicalTrials.gov NCT04287296; https://clinicaltrials.gov/ct2/show/NCT04287296
Collapse
Affiliation(s)
| | - Iain Jordan
- Method X Studios Ltd, Sheffield, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Zinc VC, London, United Kingdom
| | | | - Sophie Turnbull
- Method X Studios Ltd, Sheffield, United Kingdom.,Academic Unit of Primary Health Care, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
6
|
Zamanillo-Campos R, Serrano-Ripoll MJ, Taltavull-Aparicio JM, Gervilla-García E, Ripoll J, Fiol-deRoque MA, Boylan AM, Ricci-Cabello I. Patients' Views on the Design of DiabeText, a New mHealth Intervention to Improve Adherence to Oral Antidiabetes Medication in Spain: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031902. [PMID: 35162921 PMCID: PMC8834698 DOI: 10.3390/ijerph19031902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 02/01/2023]
Abstract
Background: Type 2 Diabetes Mellitus (T2DM) is a long-term condition affecting around 10% of people worldwide. This study aimed to explore T2DM patients’ views on DiabeText, a new text messaging intervention to be developed to support adherence to diabetes medication. Methods: A total of four focus groups were conducted with a purposive sample of people with T2DM (n = 34). The data were analysed by multiple researchers independently, and coded using thematic analysis. Results: There were two main themes that emerged: (1) “patients’ perspectives on unmet needs for diabetes self-management”, and (2) “acceptability and perceived utility of DiabeText”. The patients identified a number of barriers for diabetes self-management, including lack of appropriate information and support with diet and physical activity. Support for medication-taking was not perceived as urgently needed, although several barriers were identified (eating outside, traveling, polymedication, dispensation at the pharmacy). The participants anticipated that the proposed intervention would present high levels of patient acceptability and perceived utility as long as its content addresses the barriers that were identified, and includes specific features (short and clear messages, and personalized information). Conclusion: The proposed intervention has the potential to be well accepted and perceived as useful by T2DM patients who require support not only in terms of medication-taking, but more prominently of lifestyle behaviour.
Collapse
Affiliation(s)
- Rocío Zamanillo-Campos
- Research Group in Primary Care and Promotion—Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain; (M.J.S.-R.); (J.M.T.-A.); (J.R.); (I.R.-C.)
- Primary Care Research Unit of Mallorca (IB-Salut), Balearic Health Service, 07002 Palma de Mallorca, Spain
- Correspondence: (R.Z.-C.); (M.A.F.-d.); Tel.: +34-(97)-1175883 (ext. 76758) (R.Z.-C.); +34-(97)-1175897 (ext. 76722) (M.A.F.-d.)
| | - Maria Jesús Serrano-Ripoll
- Research Group in Primary Care and Promotion—Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain; (M.J.S.-R.); (J.M.T.-A.); (J.R.); (I.R.-C.)
- Primary Care Research Unit of Mallorca (IB-Salut), Balearic Health Service, 07002 Palma de Mallorca, Spain
- Primary Care Preventive and Health Promotion Research Network (redIAPP), 08007 Barcelona, Spain
| | - Joana Maria Taltavull-Aparicio
- Research Group in Primary Care and Promotion—Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain; (M.J.S.-R.); (J.M.T.-A.); (J.R.); (I.R.-C.)
- Primary Care Research Unit of Mallorca (IB-Salut), Balearic Health Service, 07002 Palma de Mallorca, Spain
- Primary Care Preventive and Health Promotion Research Network (redIAPP), 08007 Barcelona, Spain
| | - Elena Gervilla-García
- Psychology Department, University of the Balearic Islands (UIB), 07120 Palma de Mallorca, Spain;
- Statistical and Psychometric Procedures Applied in Health Science, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
| | - Joana Ripoll
- Research Group in Primary Care and Promotion—Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain; (M.J.S.-R.); (J.M.T.-A.); (J.R.); (I.R.-C.)
- Primary Care Research Unit of Mallorca (IB-Salut), Balearic Health Service, 07002 Palma de Mallorca, Spain
- Primary Care Preventive and Health Promotion Research Network (redIAPP), 08007 Barcelona, Spain
| | - Maria Antonia Fiol-deRoque
- Research Group in Primary Care and Promotion—Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain; (M.J.S.-R.); (J.M.T.-A.); (J.R.); (I.R.-C.)
- Primary Care Research Unit of Mallorca (IB-Salut), Balearic Health Service, 07002 Palma de Mallorca, Spain
- Correspondence: (R.Z.-C.); (M.A.F.-d.); Tel.: +34-(97)-1175883 (ext. 76758) (R.Z.-C.); +34-(97)-1175897 (ext. 76722) (M.A.F.-d.)
| | - Anne-Marie Boylan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK;
| | - Ignacio Ricci-Cabello
- Research Group in Primary Care and Promotion—Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain; (M.J.S.-R.); (J.M.T.-A.); (J.R.); (I.R.-C.)
- Primary Care Research Unit of Mallorca (IB-Salut), Balearic Health Service, 07002 Palma de Mallorca, Spain
- Biomedical Research Center in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| |
Collapse
|