Who is the ‘digital consumer’ in chronic disease?

Rachel Skevington Britton, associate director, healthcare at market research agency, Simpson Carpenter, argues that while patient-centric design is the new mantra of the digital healthcare space, there is a tendency to assume that in this Generation Z world, people with chronic conditions are just waiting for a digital solution to meet their needs.

There's a dominant narrative in healthcare circles right now that digital solutions have the potential to transform and radically improve how virtually any chronic condition is managed. But just as in sectors like media, travel and finance, this is an oversimplification that fails to take account of the barriers that prevent many people from engaging with these technologies.

In healthcare, a key problem is the assumption that everybody is willing or able to use digital tools with the confidence and dexterity of the mobile-first, Generation Z community. However, the reality is that this isn’t always the case for the growing number of people suffering from chronic health conditions.

My ten years’ experience as a health and social care researcher tells me we must challenge the assumption that patients with chronic conditions will always embrace and benefit from a tech solution. Instead, we should focus on understanding the patient and their management of their own condition, before we start to imagine we have invented the solution to all their problems.

Unquestionably, digital tech presents some amazing opportunities for data collection, medication reminders and provision of information and support. But there are three significant barriers to adoption of digital health solutions among people with chronic conditions that need to be considered.

Challenge 1: Practical barriers to adoption

Because many innovators in the healthcare field are either digital natives or Generation Xers who effortlessly embrace innovation, they often imagine that everyone is comfortable with game-changing tech. But there’s plenty of data to show that people with chronic conditions tend to be older, or come from poorer socio-economic groups. Neither of these groups find it easy to embrace digital solutions – even if they are proven to work and have been created to deal specifically with their condition.

On the issue of age, inaccurate assumptions are often fuelled by the fact that many of us have a parent or grandparent who is a Facebook fanatic or a keen texter. But research shows us that there is still a huge digital divide even in advanced markets. In the UK, for example, 47% of people aged 75+ have never used the internet, along with 14% of those aged 65-74. The implication here is that they lack the technical literacy to identify, access and use a digital health solution without support.

Ability and desire to use digital tech are not the only barriers to its usage – a fact that is evident when we look at another disproportionately-represented group among those with chronic diseases – people in lower socio-economic brackets. In the US, the Pew Research Centre found that only 71% of those earning less than $30,000 a year owned a smartphone, compared to 95% of those in the $75,000+ category. There‘s a similar pattern in educational attainment. Assuming similar patterns with smart speakers and smartwatches, access becomes a major challenge.

Challenge 2: Emotional barriers to engagement

Another classic misconception is the idea that people with chronic conditions will automatically embrace any digital solution designed to combat it. However, there are complex emotional and psychological reasons why some people might reject support – even if it seems like a no-brainer.

A research study by the Kings Fund explored this idea further. It found that a major driver of reluctance to engage with support and solutions is that patients often don't want to think about the diagnosis of a condition that will be with them for life – and by extension, are resistant to considering a potential solution. Crucially, they may not want their sense of identity to be altered to that of a 'sick person'.

Coming to terms with the diagnosis of a chronic disease can take time. During this transition period, patients often don't want to change their daily life, hoping instead that they can delegate all aspects of their care to medical professionals without making meaningful adjustments to their own behaviour.

Those emotional and psychological nuances vary from person to person, and from condition to condition. Inevitably, this means there is no simple ‘one size fits all’ solution for chronic diseases. But the viability of digital offerings will hinge on how well developers understand the lived experience of people with chronic conditions, and determine how technology can best fit into their lives.

Challenge 3: 'I've just got to soldier on'

In every society, there is a group of people who prefer to ‘tough it out’ alone rather than engaging with support, and it is often these people who struggle the most with their chronic conditions. Or to put it another way, people who access support have better health outcomes and better quality of life than those who soldier on alone – and there is growing evidence that this is true of digital, as well as ‘traditional’, support mechanisms.

If we want to make a real difference, it is not enough to shoot for the ‘digitally savvy’ minority who are already engaged with existing digital support tools, and hope your idea will interest them. Rather, it is vital to engage a wider group, ensuring digital solutions are targeted and tailored to appeal to those who don’t use existing support mechanisms, and so stand to benefit most from the support they offer.

The way ahead

It’s easy to overlook the digitally-disenfranchised – those who are unable or unwilling to access next-gen healthcare solutions for all of the reasons given above. But there is plenty of evidence to show that the right approach, delivered by the right people through the right channels, can increase empowerment and engagement among those living with chronic diseases and conditions.

For example, in Hampshire, UK, local commissioners implemented a selection of small-scale digital care solutions, including providing users of adult social care services with an Amazon Echo to help meet their information needs. They also installed sensors on the doors of people with dementia; if the door is opened at an unusual time, a familiar voice is activated, suggesting they stay indoors. These simple and intuitive interventions saved £9.8 million over the first five years and drove high user satisfaction, with 98% of service users saying they would recommend it to others.

This project worked because the team thought first about the problems experienced by these patients and only then considered how potential tech solutions would fit into their daily lives.

The best way to stay patient-focused is to give the end-user a seat at the ‘design table' (along with their doctors, nurses and carers). Nothing beats hearing about the lived experience of a client group and gathering their feedback on new solutions. My belief is that this is the only way that we will create effective digital products for patients with chronic conditions, and so deliver a net benefit to their health.