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.
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.
| Original language | English |
|---|---|
| Article number | e080055 |
| Number of pages | 10 |
| Journal | BMJ Open |
| Volume | 14 |
| Issue number | 3 |
| Early online date | 5 Mar 2024 |
| DOIs | |
| Publication status | Published - 5 Mar 2024 |
Data Availability Statement
Data are available upon reasonable request. Anonymised datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.Funding
This project was funded by the GW4 Digital Crucible seedcorn funding grant. GL was funded by the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, in partnership with UK Health Security Agency (UKHSA).
| Funders | Funder number |
|---|---|
| National Institute for Health and Care Research | |
| GW4 | |
| Health Security Agency | |
| University of Bristol | |
| UKHSA |
Keywords
- Humans
- Digital Health
- Pandemics
- COVID-19/epidemiology
- Health Facilities
- Secondary Care