Digital healthcare platforms must focus on inclusion

COVID-19 has brought the issue of digital inclusion to the fore. According to NHS Digital, 20% of UK adults lack basic digital skills, while 12% did not use or have access to a digital device in 2020. The pandemic shifted many aspects of our daily lives online, from working remotely and connecting with family to, in many cases, seeking medical advice from a doctor.

While this shift to online services has been transformative for some, it has left the digitally excluded cut off. As healthcare providers, we must do everything in our power to address this, embedding principles of inclusion into everything we do, to ensure that everyone can share in the benefits of digital. 

There is no universal definition for the ‘digitally excluded’, but the term could include people with disabilities; people on lower incomes who struggle to afford laptops and mobile phones, or access to the internet; older people who are less confident using digital devices; and people who may find it difficult to use digital services in English as this is a second language.

When designing digital health products like apps, these groups can be unintentionally overlooked at various stages of the process, from conception of the idea, all the way through to the build. The simplest way to avoid this is to start every product design or development journey with inclusion front of mind. From this starting point, there are several other areas providers should consider.

Designing accessible platforms

At the most basic level, digital health apps must be accessible through elements like colour contrast, layout and usability. But when thinking about this through the lens of a patient who is, for example, partially sighted or deaf, we need to take it one step further. This need is underlined by a recent UK Consumer Digital Index finding that people with a disability are 35% less likely to have essential digital skills. 

Online plug-ins like Silktide allow you to to run through any webpage from the perspective of someone with dyslexia, colour blindness, cataracts, tunnel vision or blindness. This is a valuable learning experience that can teach the importance of simple things like alt-tags, which provide a text alternative description to an image on a page.

Alongside this, using personas for digitally excluded groups and involving them in user testing enables designers to understand how someone will respond to different product features and gather feedback on how they could be improved or adapted. Ultimately, meeting as many Web Content Accessibility Guidelines (WCAG) guidelines for web accessibility as possible is what all digital health providers should aim for.  

Putting the right support in place

For the millions of people who struggle to access or use technology, using a digital health app can feel daunting and unfamiliar, so it is crucial that providers have the right support in place to make the experience as successful as possible. At Push Doctor, we have set up a new ‘Digital Ambassadors’ scheme which aims to support and empower patients struggling with online services.

Whether this is down to difficulties using a mobile device, needing help navigating our platform for the first time, or just wanting some extra guidance, the initiative offers an ‘ask-us-anything’ session with an expert from our Patient Experience team.

Digital Ambassadors give patients as much time as they need to feel comfortable using the service, even staying with them right up until their consultation begins. All patients are also able to access video tutorials on our website and on YouTube. Through programmes like these, providers can help build confidence and enable people to take charge of their digital health. 

Addressing health inequalities through innovation

As Covid-19 restrictions ease and some normality resumes, digital health services become a bigger part of the way we access healthcare, and the ability to access digital technologies will become more important. The World Health Organisation has good evidence that people with lower health literacy have worse health outcomes, which brings the need to tackle these inequalities into focus, so digital health can be accessible and beneficial to everyone. 

At Push Doctor, one solution we are currently trialling is bookable, sound-proofed video ‘pods’ with computers in community spaces like libraries. These pods allow any patient to walk in and have a private digital consultation, with staff on hand to give practical advice on using the technology. These innovations go hand in hand with the NHS’s commitment to improving digital literacy and helping patients manage their care with its Widening Digital Participation initiative.

Offering flexibility to support different needs

For digital platforms to be truly inclusive, they must have the ability to adapt to different patient needs, including those who do not have English as their first language. For these patients, it may feel more comfortable to use digital services like video consultations with a translator who can help them get the most from the experience.

While adding live translation services is complex, it is an important step in widening access to digital services, particularly in communities with a high volume of non-native English speakers. This is something we are currently trialling for 300,000 people in Hounslow - one of London’s most diverse boroughs - by giving patients the ability to request a Polish interpreter to join video consultations in seconds alongside the GP.

Other languages will also be introduced in a phased rollout across Hounslow, where Polish is the second most spoken language. Alongside this, digital providers should cater for patients that need to see a clinician of a specific gender, for reasons such as religion. 

Digital inclusion is not just for the 11.3 million people in the UK who lack basic digital skills, it’s for all. Any app or platform that is designed and developed with inclusivity in mind will benefit everyone’s experience of the service, not just the digitally excluded.

That said, as an industry, we must work to combat these inequalities, both pre-existing and reinforced by the Covid-19 pandemic. Collaboration is urgently needed to prevent people in the UK experiencing differences in healthcare based on factors often outside their control and enable everyone to share in the benefits of digital.