DISC Study Publications

Review of UK policies for digital health, cardiometabolic disease and ethnicity between 2010 and 2022

Health policies in the UK and internationally have recently focused on digital health care, such as apps, websites and devices that can monitor health or exercise. These policies set out plans for the future of digital health care that have been agreed by government Departments and other organisations.

We looked at UK government policies around heart disease and diabetes, together known as cardiometabolic disease, and digital health, to understand how well they considered the needs of minority ethnic groups. People of Black and South Asian backgrounds in the UK have a higher risk of heart disease and diabetes. Looking at these policies can help us understand what recommendations are needed, to ensure that policy is used to benefit everyone.

We selected eighty-seven policies from the last 10 years for this review which mentioned at least one of the following: digital health and health data, health inequalities, and cardiometabolic disease. About half of the policies were about the health and social care system, and public health. Seventeen policies covered the whole of the UK, thirty-four policies focused on England, fifteen on Scotland, nine on Wales, and seven on Northern Ireland.

We found that over time there has been more emphasis on how digital health could be helpful in the prevention, diagnosis and management of cardiometabolic disease. The various impacts of the COVID-19 pandemic on different groups in the UK population has led to more focus in inequalities in UK policies. An overview of the key policies can be found in this timeline.

We did not find any policies which considered all three factors together: digital health, cardiometabolic disease, and ethnicity. We recommend that future policies should focus on:

·      Differences between and within minority ethnic groups in the UK

·      The interaction between factors that affect health and access to digital tools (such as education, job, income, housing, social networks, and environment)

·      Looking more closely at digital health tools for specific conditions, and how these can be tailored to support the diverse population.

You can read the full paper here: https://doi.org/10.1057/s41271-023-00410-z

Review of evidence for how digital health interventions for cardiometabolic disease are used in South Asian and Black minority ethnic groups 

Digital health interventions, such as apps, websites and wearable devices are becoming more common to help people prevent and manage diabetes and heart disease, together known as cardiometabolic disease. We wanted to bring together evidence on how digital health interventions for cardiometabolic disease are used in South Asian and Black minority ethnic groups, who have a higher risk of these diseases. This can help us understand how to best design digital health interventions, and introduce and support people to use them, so that they can get the most benefit from them.

We selected fifteen studies for this review. These studies had tested digital health interventions or asked people about their experiences of using them. Thirteen of these studies focused on people with an African-American background, and two studies looked at the experiences of the South Asian diaspora, one in the UK, and one in Canada. We found that digital health interventions would be acceptable and beneficial to individuals in these ethnic minority groups if specific factors were considered during the design, introduction and ongoing use. These included: 

• Taking into account patients’ beliefs, health needs, education and literacy levels, and material circumstances – for example, making sure that the language used to share information on a healthy diet is clear and includes different cultural foods 
• Patient’s culture, social networks, and wider community – for example, introducing and teaching people how to use a new digital health intervention at a community or religious centre 
• The technical and design aspects of the digital health intervention – for example, making sure the design is simple and it is easy for users to find what they are looking for.  
• Connecting digital health interventions with the supporting health care systems – for example, allowing people to share information with their health care provider 

Using our findings, we have created a guide to help future researchers and developers design cardiometabolic DHIs for minority ethnic groups. 

You can read the full paper here at: https://doi.org/10.2196/40630 

Review of frameworks used to understand how digital health interventions are accepted and used in ethnic minority populations, with a focus on cardiometabolic disease.

The use of digital health interventions, such as apps and websites, is becoming more common to help people manage health conditions. However, uptake and use of these types of health technologies may vary among people from different backgrounds.

There are many frameworks that describe or predict how digital health interventions are accepted or used. ‘Framework’ refers to a model or theory that explains how different aspects together lead to an end result. We wanted to understand how these frameworks consider the differences between population groups. For this purpose, we explored how features and actions of patients, digital technologies, health care providers, and government, might lead to the success or failure of a new digital health technology. We focussed on heart disease and diabetes (sometimes referred to together as “cardiometabolic disease”) in the South Asian population, as this group experiences a higher risk of developing these conditions and may also be more likely to experience health inequalities.

We identified and reviewed 58 publications, among which 22 (38%) included frameworks that focused on digital health, heart disease and diabetes, and/or health inequalities.

Only five of the frameworks we found considered inequalities at all levels:

·      Individual (e.g. patients and members of the public)

·      intervention (e.g. treatment or technology)

·      health care system (e.g. the NHS)

·      society (e.g. government)

We found three frameworks that described how digital health might interact with the existing health inequalities; and three that suggested opportunities to make digital health more equitable (fair).

Most frameworks did not mention ethnicity at all.

Using the identified frameworks, we have created a guide of the factors that people can use to understand inequalities in digital health. We hope that this will be useful for future research, and for those who make digital health policy.

You can read the full paper here at: http://dx.doi.org/10.2196/37360