Department of Musculoskeletal Therapy, St George's University Hospitals NHS Foundation Trust, London, UK.
Innovation and Transformation Team, NHS South West London Integrated Care Board, London, UK.
Musculoskeletal Care. 2024 Sep;22(3):e1925. doi: 10.1002/msc.1925.
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.
METHODS/DESIGN: 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.
数字自我管理平台被提议作为一种解决方案，可以更好地支持人们管理他们的肌肉骨骼 (MSK) 状况。然而，研究往往明确排除了那些无法访问联网设备的人。一个重要的考虑因素是，这些新的数字选择将使那些无法访问联网设备的人（数字排斥）面临更加恶化的医疗保健不平等和不公平现象。
评估伦敦西南部 (SWL) MSK 自我管理应用程序的可接受性和数字排斥的潜在原因。
(1) 探索为什么有些患者不使用该应用程序，以及他们遇到的障碍；探索为什么有些临床医生不开具该应用程序。(2) 根据这些发现提出建议，以改善数字包容性。
方法/设计：这是一项解释性顺序混合方法服务评估，包括最初的问卷以确定合适的合作者，然后对患者和临床医生进行结构化访谈。
经过全面数据分析，10 个子主题被分为四个主要主题：(1) 信念：理解数字作用的重要性；面对面咨询仍然受到重视并需要。(2) 障碍：数字素养不足；缺乏体检/与临床医生接触。(3) 促进因素：即时获得建议和信息；感知更好地控制健康；易于使用；无需预约。(4) 解决方案：支持和培训；提高认识。
随着数字健康技术的发展，战略必须改变，需要刻意的工作和投资来提高包容性。我们的研究结果强调了数字技术的设计和交付如何适应解决数字排斥的原因。
