The Healthcare Improvement Studies Institute research fellow.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Br J Gen Pract. 2024 Mar 27;74(741):e250-e257. doi: 10.3399/BJGP.2023.0412. Print 2024 Apr.
Remote and digital services must be equitable, but some patients have difficulty using these services. Designing measures to overcome digital disparities can be challenging for practices. Personas (fictional cases) are a potentially useful tool in this regard.
To develop and test a set of personas to reflect the lived experiences and challenges that older people who are disadvantaged face when navigating remote and digital primary care services.
Qualitative study of digital disparities in NHS community health services offering video appointments.
Following familiarisation visits and interviews with service providers, 17 older people with multiple markers of disadvantage (limited English, health conditions, and poverty) were recruited and interviewed using narrative prompts. Data were analysed using an intersectionality lens, underpinned by sociological theory. Combining data across all participant interviews, we produced personas and refined these following focus groups involving health professionals, patients, and advocates ( = 12).
Digital services create significant challenges for older patients with limited economic, social, and linguistic resources and low digital, health, or system literacy. Four contrasting personas were produced, capturing the variety and complexity of how dimensions of disadvantage intersected and influenced identity and actions. The personas illustrate important themes including experience of racism and discrimination, disorientation, discontinuity, limited presence, weak relationships, loss of agency, and mistrust of services and providers.
Personas can illuminate the multiple and intersecting dimensions of disadvantage in patient populations who are marginalised and may prove useful when designing or redesigning digital primary care services. Adopting an intersectional lens may help practices address digital disparities.
远程和数字服务必须公平，但有些患者难以使用这些服务。对于医疗机构来说，设计克服数字鸿沟的措施可能具有挑战性。角色（虚构案例）在这方面是一种有用的工具。
开发和测试一组角色，以反映处于不利地位的老年人在远程和数字初级保健服务中导航时所面临的生活经历和挑战。
对提供视频预约的 NHS 社区卫生服务中的数字差距进行定性研究。
在对服务提供者进行熟悉访问和访谈后，招募了 17 名具有多种劣势标记（英语有限、健康状况和贫困）的老年人，并使用叙事提示对他们进行访谈。使用交叉性视角分析数据，以社会学理论为基础。我们结合了所有参与者访谈的数据，制作了角色，并在包括卫生专业人员、患者和拥护者在内的焦点小组（= 12）参与下对这些角色进行了完善。
数字服务为经济、社会和语言资源有限且数字、健康或系统知识水平较低的老年患者带来了重大挑战。制作了四个具有鲜明对比的角色，捕捉了劣势的各个维度如何交叉并影响身份和行动的多样性和复杂性。这些角色说明了重要主题，包括经历种族主义和歧视、迷失方向、不连续、存在感有限、关系薄弱、失去代理权以及对服务和提供者的不信任。
角色可以阐明处于边缘地位的患者群体中劣势的多个和交叉维度，并且在设计或重新设计数字初级保健服务时可能会很有用。采用交叉性视角可能有助于医疗机构解决数字差距问题。
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