20 Digital health: Analysing patients’ education, inclusion and use of different online NHS services

Introduction Over 4 weeks in June 2023, I carried out a mixed qualitative and quantitative patient survey across 3 GP locations which were part of Willows Health Trust. The team involved included a clinical psychologist and IT officer at Willows Health Trust. The target audience was the GP management team (practice managers), administration staff members, GPs, clinical psychologists and IT officers. 1The specific challenge being addressed was assessing patient's awareness, inclusion and education of digital NHS resources. Digital health exclusion is something that can be seen as social inequality and in a way feeds into the inverse care law whereby patients that most need health care are unable to access it (physically, socially and/or digitally). This was important to assess since there are reports which explain how digital exclusion could consequently negatively impact on health inequalities. This topic is vast and the reasoning behind the access to NHS digital resources is multifactorial stemming from wi-fi connectivity issues, digital health literacy, financial stability, concerns around data breaches and simply having access to a digital device to name a few. Therefore, by carrying out a mixed qualitative and quantitative patient survey, I was able to analyse patient education and use about such online resources in order to gain certain intervention methods that could be carried out on a local scale. Aims and objectives of the research project or activity Over the course of the project, 32 patients were surveyed in GP waiting rooms and patient IT drop-in sessions across 3 different GP practices (which were all under Willows Health Academy) regarding their own awareness and use of NHS digital health services. In terms of the key stakeholders, regular meetings with the IT support officer and clinical psychologist were arranged to agree on the survey questions and to address patient concerns during the IT drop-in sessions. The analysis was disseminated in a GP practice meeting which was targeted to practice managers, administration staff, GPs, clinical psychologists and IT support officers. Method or approach The impact of this project was applicable on a local level (parts of Leicestershire) and the degree to which it modified the initial challenge still needs to be assessed after analysing data from the same survey on patients after a year to assess whether intervention methods made any positive changes. Some problems encountered during the process included not being able to survey the anticipated target of 50 patients due to timing difficulties. This project has positive benefits on both a patient level and a GP trust level; being able to address barriers to digital health inclusion and understand certain strategies in accordance to change management can provide efficiency on both sides whilst also reducing the digital exclusion disparity on a patient level and providing economical benefits to the practice (as it serves as a sustainable way in dealing with different patient needs more efficiently since a lot of time is saved by doing things digitally). Better patient inclusion could also lead to improved management of long term conditions by empowering patients with the knowledge of how to manage things digitally as well as increasing patient adherence to medication since it may be easier and quicker to book for repeat prescriptions online. This work contributes to a core focus of leadership and management because the interventions will be assessed after a Change management plan is organised by re-introducing the same/similar patient survey to the GP patients after 1 year to assess whether intervention strategies were successful or not and what else could be introduced. The change management plan would involve leadership from the GP practice managers and IT communication officers perhaps using models such as the ADKAR model to aid with the planning process. This work could be reproducible by others by following the same surveying structure and questions and by using the same survey to ask a different patients the same questions. It may be more efficient to send the survey digitally via text message and by letters (which could then be posted to the GP or handed to the receptionists at GP practices) in accordance to the relevant communication preferences the patient listed on their registration forms. Findings On reflection of this project, I learnt about the complexities behind digital exclusion and ways that we can support patients accessing information online. For example, this can be due to language barriers, technological barriers, varying levels of digital literacy and access to online devices to name a few. I also learnt about the process behind Change Management plans and how we can assess certain intervention plans in the future. Things that I would do differently would be that I would go to all 10 GP practices that were part of the Willows Health Academy in order to obtain a more varied sample size and also gain a larger sample size. This would have been helpful to assess any other patient feedback or suggestions regarding digital NHS services. Alternatively, to be more efficient, I would send the survey or a shorter version of the survey via text messages or letters in accordance to the patients' communication preferences. In terms of measuring any improvement, I intend to survey patients across the 10 different GP practices in a year's time with aims to gain a larger sample size of around 500 patients by sending copies of the survey via text message or letters (where patients can then drop in to the GP practice). I will compare the qualitative data with the previous survey to see if any improvements are made on patient satisfaction about online NHS resources and to assess whether there has been an improvement in the uptake of other them. There have already been some improvements made to the Willows Health GP website which offers a clearer and easier user-interface so it would be interesting to compare patient data (qualitative and quantitative) on the next patient survey. Regarding the strategies for improvement, I believe a change management plan should be discussed in detail with the GP practice managers and IT officers to address what type of interventions should be implemented. This could be around introducing more proactive advertisements of online NHS services, IT drop-in sessions and additional support from charities such as AGE UK (which provide sessions of technological help). As well as this, it would be useful to have another practice management meeting in order to proactively involve all the different GP practices within the intervention strategies. Key messages On balance, on analysing patient responses from the survey, it is evident that not all of NHS online services (such as SystmOnline, AccuRx, GP trust website) are used to their full capacity and the reasoning to this seems to be multifactorial. Moreover, some barriers to using online NHS services are due to technological issues, confusing user interface, lack of awareness and advertising and can also depend on levels of digital literacy. This project may benefit the health care system as a whole as it has allowed us to identify Change management plans to help improve the number of patients using online services. For example, some possible considerations involve implement increased advertising about NHS online resources, advertising IT drop-in sessions, accessing support from charities such as AGE UK and improving the user interface on websites or apps to aid with understanding.