Poduval, S; Ahmed, S; Marston, L; Hamilton, F; Murray, E; (2019) Crossing the digital divide in online self-management support: analysis of usage data from HeLP-Diabetes. JMIR Diabetes , 3 (4) , Article e10925. 10.2196/10925.

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Abstract

BACKGROUND: Digital health is increasingly recognised as a cost-effective means to support patient self-care. However there are concerns about whether the “digital divide”, defined as the gap between those who do and do not make regular use of digital technologies will lead to increased health inequalities. Access to the internet, computer literacy, motivation to use digital health interventions, and fears about internet security are barriers to use of digital health interventions. Some of these barriers disproportionately affect people of older age, black or minority ethnic background, and low socioeconomic status. HeLP-Diabetes, a theoretically informed online self-management programme for adults with type 2 diabetes, was developed to meet the needs of people from a wide demographic background. OBJECTIVE: The aim of the study was to determine whether there was evidence of a digital divide when HeLP-Diabetes was integrated into routine care, by comparing (1) the characteristics of people who registered for the programme with the characteristics of people with type 2 diabetes in inner London; (2) the characteristics of people who registered for the programme and used it with people who registered for the programme but did not use it; and (3) comparing sections of the website visited by different demographic groups. METHODS: A retrospective analysis of data on the use of HeLP-Diabetes in routine clinical practice in four inner London CCGs was undertaken. Data were collected from patients who registered for the programme as an NHS service. Data on gender, age, ethnicity and educational attainment were collected at registration, and data on webpage visits (user identification number, and date, time and page visited) were collected automatically by software on the server side of the website. RESULTS: The characteristics of people who registered for the programme were found to reflect those of people with type 2 diabetes in inner London. The mean age was 58 years (SD=30), over 50.0% were from black and minority ethnic backgrounds, and nearly a third (29.8%) had no qualifications beyond high school. There was no association between demographic characteristics and use of the programme, apart from weak evidence of less use by the mixed ethnicity group. There was no evidence of differential use of the programme by any demographic group, apart from weak evidence for people with degrees and high school diplomas being more likely to use the “Living and working with diabetes” (p=0.03) and “Treating diabetes” (p=0.04) sections of the website. Conclusions: This study is one of the first to provide evidence that a digital health intervention can be integrated into routine health services without widening health inequalities. The relative success of the intervention may be attributed to integration into routine health care, and careful design with extensive user input and consideration of literacy levels. Developers of digital health interventions need to acknowledge barriers to access and use, and collect data on the demographic profile of users, in order to address inequalities.

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