Morris, Tiyi Amina Naomi; (2023) A mixed-methods exploration of the impact of digital health interventions on the use and costs of health and social care services for the management of type 2 diabetes. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background Digital health interventions (DHIs), such as smartphone applications, are increasingly used to help manage conditions such as type 2 diabetes. DHIs can augment or replace traditional health services but introduce significant new costs. While the impact of DHIs on health outcomes has been studied extensively, less attention has been paid to the economic impact. Aims This study aimed to understand impacts of DHIs for managing type 2 diabetes on costs and staff experience in health and social care services. It focused on one DHI, Liva, implemented through the NHS Test Beds programme in East London. Methods There were two systematic reviews and three empirical studies conducted as part of this thesis. The first review assessed UK-based qualitative and quantitative evaluations and the second international quantitative economic evaluations. The first empirical study was a documentary analysis of local, regional and national policy. Second, semi-structured interviews of staff and stakeholders were used to understand strategic priorities and DHI implementation. Third, linked health and social care data were analysed to assess Liva’s cost impacts. The empirical findings were then combined by using a joint display process for a concurrent mixed method synthesis. Results The reviews identified factors affecting patient experience and cost types more likely to be impacted by DHIs, which informed the empirical study designs. The studies found that local policies were adapted closely from national ones and prioritised tackling the social determinants of health. However, significant implementation challenges were found by staff, and the evidence for cost savings was not statistically significant. The synthesis highlighted disconnects in practice between the planning and implementation of DHIs. Conclusion The findings illustrate the potential of data linkage across health and social care and the mixed methods synthesis to help understand the relative costs and benefits of DHIs in a real-world context.

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