Recommendations to advance digital health equity: a systematic review of qualitative studies

npj Digital Medicine, Год журнала: 2024, Номер 7(1)

Опубликована: Июнь 29, 2024

Abstract The World Health Organisation advocates Digital Technologies (DHTs) for advancing population health, yet concerns about inequitable outcomes persist. Differences in access and use of DHTs across different demographic groups can contribute to inequities. Academics policy makers have acknowledged this issue called inclusive digital health strategies. This systematic review synthesizes literature on these strategies assesses facilitators barriers their implementation. We searched four large databases qualitative studies using terms relevant technology, inequities, socio-demographic factors associated with exclusion summarised by the CLEARS framework (Culture, Limiting conditions, Education, Age, Residence, Socioeconomic status). Following PRISMA guidelines, 10,401 articles were screened independently two reviewers, ten meeting our inclusion criteria. Strategies grouped into either outreach programmes or co-design approaches. Narrative synthesis highlighted three key themes: firstly, user-friendly designs, which included software website interfaces that easy navigate compatible existing devices, culturally appropriate content, engaging features. Secondly, providing supportive infrastructure users, free connectivity, non-digital options help healthcare. Thirdly, educational support from family, friends, professionals individuals develop literacy skills DHTs. Recommendations equity include adopting a collaborative working approach meet users’ needs, effective advertising raise awareness available support. Further research is needed assess feasibility impact recommendations practice.

Язык: Английский

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Patient safety in remote primary care encounters: multimethod qualitative study combining Safety I and Safety II analysis

BMJ Quality & Safety, Год журнала: 2023, Номер 33(9), С. 573 - 586

Опубликована: Ноя. 28, 2023

Background Triage and clinical consultations increasingly occur remotely. We aimed to learn why safety incidents in remote encounters how prevent them. Setting sample UK primary care. 95 (complaints, settled indemnity claims reports) involving interactions. Separately, 12 general practices followed 2021–2023. Methods Multimethod qualitative study. explored causes of real retrospectively (‘Safety I’ analysis). In a prospective longitudinal study, we used interviews ethnographic observation produce individual, organisational system-level explanations for near-miss (rarely) occurred they did not more often II’ Data were analysed thematically. An interpretive synthesis occur, do often, was refined following member checking with experts lived experience experts. Results Safety characterised by inappropriate modality, poor rapport building, inadequate information gathering, limited assessment, pathway (eg, wrong algorithm) attention social circumstances. These resulted missed, inaccurate or delayed diagnoses, underestimation severity urgency, referral, incorrect treatment, netting follow-up. Patients complex pre-existing conditions, cardiac abdominal emergencies, vague generalised symptoms, safeguarding issues, failure respond previous treatment difficulty communicating seemed especially vulnerable. General facing resource constraints, understaffing high demand. care pathways complex, hard navigate involved multiple staff. this context, patient depended on individual staff taking initiative, speaking up personalising solutions. Conclusion While are extremely rare care, deaths serious harms have resulted. offer suggestions patient, mitigations.

Язык: Английский

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Video consultation in general practice: a scoping review on use, experiences, and clinical decisions

BMC Health Services Research, Год журнала: 2023, Номер 23(1)

Опубликована: Март 30, 2023

Abstract Background The coronavirus disease 2019 pandemic forced healthcare workers to use alternative consultation approaches. In general practice, the of video consultations (VCs) increased manyfold as countries were locked down. This scoping review aimed summarize scientific knowledge concerning VC in practice and focused on (1) utilization (2) experiences users (3) how affected clinical decision-making practitioners (GPs). Methods A was conducted accordance with methodology Joanna Briggs Institute. Review questions formulated match each focus area. three-step search strategy employed gray literature sources. MEDLINE, Embase, Scopus, OpenGrey, Google Scholar, ClinicalTrials.gov searched from 2010 March 11 th , 2021, re-run August 18 2021. extracted data deductively coded into pre-defined main themes, whereas subthemes inductively synthesized. within subtheme analysed through descriptive content analysis presented a narrative synthesis. Results Overall, 13 studies included after screening 3,624 studies. Most patients satisfied VCs. VCs most suitable for simpler issues, often shorter than face-to-face consultations, more likely be used by younger patients. GPs enjoyed flexibility duration VCs; however, they felt an unsatisfactory deterioration GP-patient relationship. Despite loss examination, diagnostic assessment mostly successful, little fear missing serious illness. Prior experience preexisting relationship patient important factors successful via VC. Conclusions Both can specific contexts, adequate is possible. However, disadvantages such diminishing have been highlighted, non-pandemic settings limited. role future remains unclear, further research needed long-term adoption practice.

Язык: Английский

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Intersectionality as a theoretical framework for researching health inequities in chronic pain

British Journal of Pain, Год журнала: 2023, Номер 17(5), С. 479 - 490

Опубликована: Июль 9, 2023

Chronic pain is experienced unequally by different population groups; we outline examples from the literature of inequities related to gender, ethnicity, socioeconomic and migration status. Health are systematic, avoidable unfair differences in health outcomes between groups people, with fundamental 'causes causes' recognised as unequal distribution income, power wealth. Intersectionality can add further theory literature; collective social identities including class/socioeconomic status, race/ethnicity, age, sexuality disabled status intersect multiple interconnected systems leading differing experiences privilege oppression which be understood axes inequities. The process knowledge creation research shaped these power, may perpetuate care it largely based on majority white, middle class, Eurocentric populations. inform epistemology (ways knowing), priorities, methodology methods. We give where intersectionality has informed a justice oriented approach across methods offer suggestions for development. use reductionist frame force unachievable objectivity complex concepts, note increasing realisation field need understand individuals within their world, recognise fluid contextual nature this.

Язык: Английский

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The impact of eHealth on relationships and trust in primary care: a review of reviews

BMC Primary Care, Год журнала: 2023, Номер 24(1)

Опубликована: Ноя. 3, 2023

Abstract Background Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding impact eHealth on patient-provider and provider-provider relationships. Methods A reviews was conducted three databases to identify papers published English from 2008 onwards. The different types relationships trust factors influencing were thematically analyzed. Results total 79 included. Patient-provider discussed more frequently as compared Communication systems like telemedicine most type technology. found have both positive negative impacts and/or trust. This influenced by a range patient-related, provider-related, technology-related, organizational factors, such patient sociodemographics, provider communication skills, technology design, implementation, respectively. Conclusions Recommendations are provided for effective equitable selection, application, training optimize findings can inform providers’ policymakers’ decision-making around use care delivery facilitate relationship-building.

Язык: Английский

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National survey on understanding nursing academics' perspectives on digital health education

Journal of Advanced Nursing, Год журнала: 2024, Номер unknown

Опубликована: Апрель 1, 2024

Abstract Aim This study explored the knowledge and confidence levels of nursing academics in teaching both theories practical skills digital health undergraduate programs. Design A cross‐sectional study. Methods structured online survey was distributed among across Australian universities. The included two sections: (1) participants' demographics their experience; (2) likert scales asking participants to rate teach four main themes; technologies, information exchange, quality professionalism. Results One hundred nineteen completed part one, 97 individuals survey. Only 6% ( n = 5) reported having formal training health. Digital mainly taught as a module 57, 45.9%), assessments theory or application curriculum were uncommon, with 79 (69.9%) responding that there no assessment entry practice Among core themes, rated high on professionalism (22.4% significant vs. 5.9% knowledge) but low exchange (30% 28.3% knowledge). Statistically p < .001) associations found between different themes level its application. Nursing more than 15 years experience had significantly higher content compared those fewer experience. Conclusion There is gap academics' nursing. need upskill prepare future workforce be capable digitally enabled care settings. Implications for Profession have limited preparing nurses work increasingly technology‐driven environments. Addressing this competency providing sufficient support regard essential. Impact What problem did address? Level practice. findings? Where whom will research an impact? Professional education globally. Reporting Method STROBE guideline used guide reporting Patient Public Contribution call participation from Australia provided introductory statement about project, aim scope, contact principal researcher. participant sheet shared detailed explanation participation. participated through link embedded invite.

Язык: Английский

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The potential and paradoxes of eHealth research for digitally marginalised groups: A qualitative meta-review

Social Science & Medicine, Год журнала: 2024, Номер 350, С. 116895 - 116895

Опубликована: Апрель 18, 2024

Whilst the transformation towards digital healthcare is accelerating, there still a substantial risk of excluding people with distance to online world. Groups like low socioeconomic position, migrant background or elderly, who are already most at experiencing health inequalities, simultaneously increased exclusion. Researchers play role in determining how eHealth access framed and can thus impact barriers its use addressed. This qualitative meta-review critically evaluates way researchers (as authors) discuss digitally marginalised groups. Specifically, it seeks understand address existing systems problems; presented which solutions provided response; authors suggest should be responsible for making work. The results this review found four paradoxes current literature views use. Firstly, that problems complex nuanced, yet seen as simple answer. Secondly, many political, social systems-based suggested use, however identified individually framed. focus on personal deficits misallocating responsibility these systemic improvements. Thirdly, although meant simplify tasks patients workers, groups often burdened ensuring success. Lastly, despite tailoring user being solution, generally speak about homogenous entity – rendering difficult. Ultimately, finds shift research addressing issues level necessary prevent further exacerbating inequalities.

Язык: Английский

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Eliminating health care inequities through strengthening access to care

Health Services Research, Год журнала: 2023, Номер 58(S3), С. 300 - 310

Опубликована: Ноя. 28, 2023

Abstract Objective To provide a research agenda and recommendations to address inequities in access health care. Data Sources Study Setting The Agency for Healthcare Research Quality (AHRQ) organized Health Equity Summit July 2022 evaluate what equity care means the context of AHRQ's mission delivery implementation portfolio. findings are result this Summit, subsequent convenings experts on from academia, industry, government. Design Multi‐stakeholder input author consensus framework key knowledge gaps, summary evidence supporting literature ensure comprehensive recommendations. Collection/Extraction Methods Through stakeholder‐engaged process, themes were developed conceptualize with lens toward equity. A working group researched most appropriate classify limitations identified during develop supported by framework. This strategy was intentional, as may itself be biased. Principal Findings Levesque et al. framework, which incorporates multiple dimensions (approachability, acceptability, availability, accommodation, affordability, appropriateness), is backdrop framing priorities AHRQ. However, addressing cannot done without considering roles racism intersectionality. Recommendations include funding that not only measures within but also tests burgeoning anti‐racist practices (e.g., co‐production, provider training, holistic review, discrimination reporting, etc.), acting convener thought leader synthesizing best mitigate racism, forging path forward access. Conclusions AHRQ well‐positioned an action plan, strategically fund it, convene stakeholders across spectrum employ these

Язык: Английский

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Toward a Values‐Informed Approach to Complexity in Health Care: Hermeneutic Review

Milbank Quarterly, Год журнала: 2023, Номер 101(3), С. 646 - 674

Опубликована: Май 23, 2023

Policy Points The concept of value complexity (complexity arising from differences in people's worldviews, interests, and values, leading to mistrust, misunderstanding, conflict among stakeholders) is introduced explained. Relevant literature multiple disciplines reviewed. Key theoretical themes, including power, conflict, language framing, meaning-making, collective deliberation, are identified. Simple rules derived these themes proposed.

Язык: Английский

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Digital health and equitable access to care

PLOS Digital Health, Год журнала: 2024, Номер 3(9), С. e0000573 - e0000573

Опубликована: Сен. 25, 2024

Research on digital health equity has developed in important ways especially since the onset of COVID-19 pandemic, with a series clear recommendations now established for policy and practice. However, research addressing system dimensions is needed to examine appropriate roles technologies enabling access care. We use highly cited framework by Levesque et al patient-centered care World Health Organization’s digitally enabled systems generate insights into that solutions can support structurally marginalized communities. Specifically, we mapped frameworks identify where applications do not care, documenting which are under-addressed health. Our analysis suggests disproportionately focused downstream enablers low-yield when goal. opportunities makers, funders other stakeholders attend more upstream enablement peoples’ abilities understand, perceive, seek out These areas an focal point interventions have potential be equity-enhancing than at time accessed. Overall, highlight importance taking perspective considering enhancing or inhibiting equitable

Язык: Английский

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