Apps to help people stop smoking, eat more healthily or exercise more are everywhere. eHealth programmes are abundant, yet they are often not accessible to people with lower incomes and levels of education. For her PhD research, Isra Al-Dhahir investigated how this could be improved.
'Technology is playing an increasingly large role in our society, and many digital healthcare applications are also being developed within healthcare,' explains health psychologist Isra Al-Dhahir, now a researcher in the Technology for Healthcare team at The Hague University of Applied Sciences. These applications are often referred to as eHealth interventions. 'Through online platforms or apps, people can receive support to lower their blood pressure or work on their mental health, for example through platforms such as Therapieland.'
Assumptions
However, says Al-Dhahir, these applications are often developed based on assumptions about what users are capable of and the circumstances in which they live. 'Many eHealth interventions are only easy to use for people who are digitally literate, have strong reading and writing skills, and possess certain health literacy skills.' As a result, people with a lower socioeconomic position (SEP) are less likely to be reached.
A widening health gap
When digital healthcare does not match people's living circumstances, existing health inequalities may increase. 'If we do not take into account how these applications fit into people's lives, we only widen the already large health disparities in society,' says Al-Dhahir. In her dissertation Striving for Equity in eHealth, she therefore examined what is needed to help professionals make digital healthcare more accessible.
Involving the target group
Al-Dhahir also investigated which barriers and facilitators professionals experience when developing, implementing and evaluating eHealth for people with a lower SEP. 'We looked broadly at all the factors involved, from the development of an application to its use and implementation.'
The results show, among other things, that it is crucial to involve the target group from the very beginning. 'Only once you understand what is happening in their daily lives can you determine whether eHealth is a suitable solution at all. For instance, you might question whether it makes sense to introduce eHealth to a target group that is deeply in debt.'
Structural conditions such as time and funding also play an important role in the sustainable implementation of suitable eHealth solutions. 'Many researchers, for example, only receive funding for four years, after which the project simply stops.'
Not a single target group
'Know your target group,' is a key message. She emphasises: 'People with less money and education cannot be placed in a single category.' Based on interviews with people with a lower SEP, she identified several groups with different attitudes towards eHealth. 'One subgroup is enthusiastic and eager to work on their health using eHealth. Another subgroup would like to improve their health but finds it complex and is afraid of making mistakes. Yet another group feels overwhelmed by the stress in their lives and may therefore be less open to eHealth.'
A practical tool for professionals
Based on conversations with professionals and people with a lower SEP, Al-Dhahir and her colleagues developed an online guide for inclusive eHealth. This guide supports professionals in making conscious choices during the design, implementation and evaluation of digital health interventions.
The guide encourages professionals to reflect on assumptions about the target group, on conditions such as guidance and funding, and on whether eHealth is genuinely appropriate in a specific situation.
Healthcare of the future
Although her PhD project has been completed, Al-Dhahir would like to further develop the guide. There is still much to be done. 'I would like to make the tips even more practical and concrete.' At The Hague University of Applied Sciences, she is now exploring whether the guide can be incorporated into teaching and how students use it when developing assignments and interventions. 'After all, they are the healthcare professionals of the future.'
