Development of methods to identify digitally excluded older people, and tailoring of interventions to meet their digital needs

BACKGROUND Digital inclusion (which includes skills, accessibility and connectivity to the internet and digital devices) is a “super social determinant of health” because it affects all other social determinants of health.

Older people are especially vulnerable to digital exclusion: an ONS survey reported only 54% of adults aged ≥75-years were recent (within the last three months) internet users.

Existing digital inclusion interventions are commonly offered opportunistically to people who come into contact with health, social care or third sector services, or in specific locations.

The lack of systematic identification of need unintentionally excludes older people who may be most in need of support (those who are ‘hardly reached’), and that support is not addressing their needs.

In line with very recent recommendations from the Digital Poverty Alliance we propose to develop a systematic identification process; explore through qualitative interviews the determinants and intersectional nature of digital exclusion; and co-produce with local groups and those who are digitally excluded interventions to address their needs.

Interventions are likely to include refinement of existing training and materials, and development of new components as required.

Research Question: can a replicable, inclusive process be established to systematically identify digitally excluded older adults (aged 65+), and can existing intervention(s) be refined and augmented to address their needs? METHODS Identification: Primary care health registers provide the most inclusive population record available.

Working with 2-3 GP practices in socially and economically diverse settings, all people aged 65+ on their registers will be identified, then contacted (initially by post) to ask about their digital use and engagement - we will use the well-tested questions from the ONS Internet Users survey.

Methods to optimise responsiveness will be utilised: an opt-out approach will allow researchers to contact directly those sent the survey if they do not opt out of participation within a specified time period; follow-up phone calls to non-responders will then be made by researchers with, where necessary, appropriate language skills in order to engage our diverse sample.

Survey data will be used to develop a model that predicts digital exclusion from data available in primary care records.

Qualitative Interviews: Twenty interviews with a sample of consenting respondents representing a range of digital use will explore key factors that influence digital behaviours (B) - their capability (C), opportunity (O), and motivation (M) relating to digital engagement (COM-B).

We will also explore participants’ views of the model developed following the survey - to potentially identify additional predictors.

Outputs from interview analysis will identify the intersectional nature of barriers or facilitators to digital inclusion, and will include illustrative case scenarios.

Mapping existing service provision: We will work with community partners to identify, understand and define the components of existing digital training and support services for older people.

To support intervention development work we will undertake a rapid review of the literature to identify emerging evidence for interventions aimed to support digitally excluded adults aged 65+.

Intervention refinement: Five co-production workshops(11) with older people (from the group of digitally included/excluded) and community service providers - informed by the interviews, case scenarios and evidence base - will identify key components of interventions that are required to address digital exclusion.

Components will be mapped against existing interventions, and the ‘best fit’ intervention(s) refined in the workshops: interventions may require tailoring for sub-groups.

An implementation plan will be developed in parallel, drawing upon appropriate theories based on the outputs of the co-production process (e.g. Normalisation Process Theory, Consolidated Framework for Implementation Research).

Feasibility testing: Identification method: The external validity of the model developed to identify those who are digitally excluded will be tested within another GP practice.

Intervention: the refined intervention(s) will be tested with 30 consenting participants (in accordance with the implementation plan) to assess acceptability and obtain feedback on content and delivery mechanisms. Data will be collected on compliance and levels of digital inclusion.

BENEFIT AND IMPACT A robust replicable system to identify digitally-excluded older adults will improve inclusion, and a co-produced intervention(s), informed by the views and needs of those who are digitally excluded, will allow provision of digital support for those who are hardly reached, thereby addressing inequalities which determine health in older adults.