Narrowing the gap – increasing engagement with digital services

Following the publication of novel research on digital inclusion in health and social care by Basis Social, Bola Akinwale, Deputy Director, National Healthcare Inequalities Improvement Programme reflects on how the NHS and wider organisations can reduce digital exclusion and narrow healthcare inequalities

The COVID-19 pandemic has shone a harsh light on the health inequalities and wider inequalities that persist in our society and which disproportionately affect groups that already face disadvantage and discrimination.

Digital channels offer the potential to enable greater equality in access to services. They can help to remove some of the practical barriers faced by individuals and enable more effective targeting of clinicians time and expertise to the people who are most likely to need support. Digital tools and technology can also make it easier to measure the reach and impact of interventions which will support services to continually improve, making sure that underserved populations are identified and supported, and aiding us in our mission to ensure equitable access, excellent experience and optimal outcomes for all.

While digital transformation of services can make it easier for some people to access care, for others digital approaches can create extra barriers to care and make it difficult for people to adopt new ways of accessing services.

Evidence indicates that a range of personal, situational and environmental factors can affect digital inclusion, for example a lack of access to equipment and internet services or poor digital literacy. However, the most commonly reported reason for not being online is motivation, or a lack of willingness to engage with and use digital technology.

That’s why thoughtful service design and finding ways to motivate digitally excluded groups should help to improve digital inclusion are so important.

NHS England’s Transformation Directorate recently commissioned research to help us better understand the behaviours of people who lack the motivation or trust to use digital services in health and social care even if they have digital access and would be able to use them in theory. This includes people in the health and social care workforce who might use different modes to deliver services, as well as members of the public who might use digital services to meet their health and social care needs.

The research was carried out by Basis Social, working in partnership with the social change charity, the Good Things Foundation. It included a survey with 1,253 respondents, 80 in-depth interviews, and workshops with service users, health and social care professionals, community group leaders, and service designers.

The findings, published today by Basis Social, offer an insight into what needs to be done to narrow the gap and motivate people to use digital health and social care services.

In brief, the research found that people’s motivation to engage with digital approaches is influenced by their belief in their own capabilities to access and use digital channels as well as their perceptions of whether digital services will:

  • deliver the expected service and support good outcomes
  • enable people to communicate their needs and feel heard
  • give individuals greater control over their care.

It also highlighted several opportunities to improve digital inclusion:

  1. presenting digital services as something that’s used by ‘people like me’. For example using trusted voices and peer-to-peer sharing to increase confidence and trust
  2. using ‘lower-risk’, more transactional services (such as ordering a repeat prescription) to get people to use digital for the first time. This will help to build familiarity with digital services and start to establish positive habits around its use
  3. making digital services as transparent and easy to understand as possible, giving people a clear indication of what they can expect
  4. increasing, opportunities for people to try digital services and learn how to use them
  5. continuing to highlight alternative service options if needed.

These insights are a must read for chief information officers (CIOs), digital leads, policy makers and service managers and will help to inform local action across the health and social care system, as well as supporting ongoing work to develop a framework for NHS action on digital inclusion.

For the full published report, please visit the Basis Social website.


Bola Akinwale

Bola Akinwale, Deputy Director, National Healthcare Inequalities Improvement Programme, is a health policy professional and has worked in a variety of national policy and strategy roles across the health and care system. She has a PhD in public health and is a member of the government social research profession.