Tackling the digital divide: evaluating and enhancing digital health intervention readiness amongst low-SES populations

Digital health interventions (DHIs) utilise digital technologies such as mobile phones, the internet, television, and environmental sensors to modify health behaviours. The short-term benefits of DHIs for improving health are well established and they are often posited as a cost-effective means of improving population health at scale. However, there is increasing recognition that digital technologies can widen rather than reduce health inequalities. This PhD will investigate the determinants of DHI efficacy and the extent to which they can be modified in underserved populations. Specifically, the work seeks to define a multidimensional construct that captures one's 'digital health readiness', create a valid instrument to measure it, and develop a brief intervention to enhance it. This work supports the Economic and Social Research Council aim of exploring public health and behaviour to keep people healthy, with a particular focus on deprived populations.
Research approach & frameworks
In recognition of the broad range of environmental and cultural factors that influence health behaviours, an interdisciplinary approach will be adopted with supervision from colleagues in health, sociology, and psychology. The research will be framed using the COM-B framework, accepting that behaviour is a combination of individual capability, opportunities and motivation. It will seek to answer the following research questions:
1. What are the psychosocial mechanisms that underpin inequalities of use and benefit in DHIs?
2. Can a new multidimensional scale that evaluates the these mechanisms and accurately predicts DHI readiness be developed?
3. Can a brief 'pre-intervention' improve DHI readiness for lower-SES DHI users applied to weight-related behaviours?
Methodologies and study design
A scoping review will be conducted to identify the most pertinent psychosocial mechanisms that underpin the digital divide in weight-related behaviours. As part of the review, a conceptual model will be developed setting out the key components (including moderating, mediating and control variables) likely to predict or explain DHI efficacy (study 1). Using this model, a DHI-readiness scale will be developed using best practice methodologies. Scale development will comprise three phases: [1] Item development - using items identified in the scoping review and content validity assessed by both experts and users; [2] Scale development - testing the refined scale with results analysed using Exploratory Factor Analysis; item difficulty, item discrimination, and inter-item and item-total correlations will also be assessed (study 2); and, [3] Scale evaluation - Confirmatory Factor Analysis and other statistical tests will be conducted to test model fit and the dimensionality of the scale items; concurrent, construct and predictive validity, as well as test-retest reliability will be assessed (study 3). Next, a 'pre-intervention' will be co-produced with users and stakeholders to improve DHI-readiness in prospective users using a person-based approach (study 4). Finally, the efficacy of the pre-intervention will be tested in a pilot randomised controlled trial to assess improvements in DHI readiness, and subsequent engagement with, and efficacy of, DHIs (study 5).
Impact
We will collaborate on the project with Swindon Borough Council; a letter of support is attached from the Director of Public Health is available. The research will have academic impact by providing a comprehensive model of the determinants of DHI efficacy to support the development of better, more effective interventions less likely to widen health inequalities. It will also have societal impact by broadening the reach of DHIs to underserved populations. The findings of this research will be disseminated to the NHS, Directors of Public Health, third sector providers and researchers through a combination of research digests, peer-review publications, social media, workshops, and conferences.