Understanding and addressing health inequalities in accessing digital healthcare for minoritized young people with ADHD: A mixed methods study

Design and methods

I will establish a PPIE group of people from minority backgrounds with ADHD, who will meet regularly to advise on ongoing research activities. Group membership will include two Research Advisory Group members of the Managing ADHD in Primary Care (MAP) study (28) [led by my Primary Supervisor], with lived experience of minority status, who have expressed interest in this project.

I will seek ethical approval for the below methods from the University of Exeter Medical School Research Ethics committee and adhere to all relevant ethical guidelines when undertaking this research. MRes

I will conduct a systematic review on access to ADHD healthcare for AYMs to explore healthcare inequalities. Using data from this synthesis I will define the minority group(s) that will be the focus of the PhD. Year 1 Study 1: Qualitative interviews with AYMs.

I will investigate participants' experiences of access to healthcare for ADHD, including potential barriers to treatment. Where specific groups are identified, I will aim to understand the beliefs and cultural norms of communities that may influence accessibility and/or information preferences. Interviews will be conducted with AYMs identified through the Diverse Devon Together network and wider recruitment adverts, until data saturation is reached (expected ~20 interviews).

Reflexive thematic analysis will be conducted using the framework approach (29). The information requirements and health messages identified through qualitative analysis will be prioritised by consultation with PPIE members, using appropriate methods (e.g., Delphi) (30). Year 2 Study 2: National quantitative survey of preferences for inclusive DHIs.

This study will engage with a community sample, using a range of strategies/networks to reach AYMs from across the UK (e.g., ADHD networks, social media) with a target minimum sample of 400. The methods will make use of lessons learned from the MAP study (28), to ensure recruitment is completed in a timely manner. The survey will be designed in conjunction with statisticians to ensure the most appropriate data are collected to conduct planned analyses.

The study will explore the extent to which participants agree with priorities established in Study 1, and practical factors impacting use of DHIs, such as mode of delivery, intervention type and language use. Research placement

Between Study 2 and 3, I will complete a 3-month placement at MindTech, hosted by the University of Nottingham. This will enable me to further develop my digital skills and learn more about developing technological innovations in health. At this time, I will start applying culturally sensitive adaptations to existing DHI components for the third study of my PhD.

Year 3 Study 3: Piloting optimised DHI components to assess acceptability and potential benefits.

An existing DHI (identified from my current systematic review - in progress) will be modified to include components which integrate the needs and preferences of AYMs generated in studies 1 and 2. The optimised DHI will be disseminated to a community sample to collect acceptability data alongside other outcome measures, such as knowledge about ADHD and self-efficacy, which will be refined throughout the course of the PhD.

To support recruitment, I will ask participants from the national survey for expressions of interest in this pilot.

I will schedule one month of dedicated writing time at the end of each study/year, and complete data collection three months prior to the end of the funded period, to facilitate write-up of my thesis.