Abstract
Background: The ambition of digitally enabled healthcare in the NHS Long-Term Plan was accelerated almost overnight in response to Covid-19. Uptake of digitally enabled consultations was widespread but lived experience feedback suggested some were left behind and wider determinants of health inequalities such as ethnicity and poverty mediated this disparity.
The NHS's Widening Digital Participation Programme, identified internet access and digital skills as crucial components for maintaining health and wellbeing. Our project helps tackle this by supporting individuals to access digitally enabled consultations and is an opportunity to think about new ways of supporting those receiving care.
The Powering Recovery Service was established by the NHS Trust with Voluntary Sector partners using Charitable funds to deliver a targeted digital inclusion programme to provide devices and data to those who do not have access, as well as skills to individuals accessing health services to enable them to access digital interventions and to support self-management of long-term conditions.
Aims: To understand the digital needs of local people, to support digitally enabled consultations and positively to impact people’s wellbeing. The target population for this pilot was individuals accessing our services with long-term health conditions.
Methods: The established service comprised three arms:
- Device and Data Provision
- Skills Training (1:1 and Group)
- Linking People with Existing Online Services:
Surveys were conducted pre- and post- intervention using quality of life and digital confidence measures.
Results:
158 individuals were enrolled in the service, 140 from BAME backgrounds; 42 aged >65. 111 completed the post-intervention surveys.
22% reported no family/friends able to support with digital matters; 15% had no internet access.
70.3% reported never having ordered repeat GP prescriptions online.
Parametric paired samples t-tests were performed on ONS Quality of Life data. Life Satisfaction, Life Worthwhile, Happiness and Anxiety, were compared pre- and post- intervention. Data was compared to Ealing Census Data (2021) to discern differences within the cohort targeted by Powering Recovery.
A key measure evaluated pre- and post- intervention was participants’ wellbeing, assessed by the Office of National Statistics Personal Wellbeing Survey (ONS4).
Wellbeing appeared to improve for individuals supported, with notable progress in life satisfaction and happiness. Participants exhibited lower levels of wellbeing at baseline than the general population in Ealing. However, post-support, their reported values more closely aligned with local population averages.
Digital confidence was measured using a 1-5 Likert scale. Pre-intervention scores (Mdn=3) improved post-intervention (Mdn=4) (z=4.88, p=0.001, r=0.50).
Qualitative feedback themes included:
- Enabled access to healthcare
- Improved ability to stay in touch
- Access to employment skills
Conclusions: Since the service began, the project demonstrated increased confidence in digital skills for individuals with long-term conditions, as well as improved mental wellbeing and life satisfaction. The service showed integration and collaboration with multiple stakeholders and promising results in targeting individuals who require support.
Participants reported an increase in confidence in accessing health services online, attributing enhanced confidence to the support provided.
Limitations include changing expectations around loan devices, variations in interventions provided and heterogeneity within the cohort.