Language and terminology
In this research, terminology has been carefully selected to ensure sensitivity to the diverse characteristics of the population groups studied. We have described the socioeconomic and demographic variables in terms of deprivation levels, ethnic backgrounds, age groups, and health status to clearly present differences in disease burden and access to digital health resources. Language used in the report aims to reflect inclusivity and accuracy, and to not assume homogeneity within these groups.
Consideration of disease burden and epidemiological differences
The study extensively examines the differences in the application of the NHS App among various population groups, focusing on the disparities in usage rates linked to the broader epidemiological context of health inequalities. It considers how existing preventative, screening, or diagnostic strategies might be differentially accessed through the NHS App. For example, the study highlights how demographic variables such as age and ethnicity influence the utilisation of specific app functions like medical record views or prescription orders, potentially reflecting varying disease burdens across these groups.
Generalisability and transferability of evidence
Findings from this research are intended to be generalisable to broader NHS settings, albeit with an understanding of the inherent limitations of both the qualitative approach, and the use of aggregated, practice-level data in the quantitative work. Insights into how different demographic groups engage with digital health tools can inform the development and adaptation of similar apps in different regions or contexts, enhancing their relevance and effectiveness.
Participant representation
The quantitative work prioritised comprehensive participant representation by analysing data from a national scale across England, encompassing diverse GP practices. By categorising these practices into quartiles and quintiles based on sociodemographic indicators, the research ensures a nuanced analysis that considers the gradient of deprivation and demographic diversity.
Enrolment and retention of diverse participants
In the qualitative work, we used theoretical and maximum variation sampling to ensure a diverse sample of patient/public participants, with diversity achieved in terms of their age, gender, ethnicity, caring responsibilities, and diverse experiences of illness and access to health services. While the quantitative work did not involve direct enrolment of participants (as it used existing databases), the population samples analysed were representative in terms of their diverse demographic characteristics.
Participant data
Careful attention has been given to the handling of participant data, with measures to protect confidentiality, privacy and ensure data integrity. The quantitative work only used aggregated data without personal identifiers, adhering to ethical standards and data protection regulations. This approach respects participant confidentiality while allowing for the analysis of significant trends across population groups.
Reflections on the research team and wider involvement
Our research team comprises individuals from diverse academic and professional backgrounds, which enriches our approach to the EDI aspects of the study. We also engaged with patient and public groups to validate our findings and methodologies, ensuring that the perspectives of app users from varied backgrounds are considered in interpreting the data and formulating recommendations.
Conclusion
This work incorporated diverse perspectives in the evaluation of the NHS App. By understanding and addressing the disparities in NHS App usage, we aim to contribute to more equitable healthcare outcomes through improved digital health services. Moving forward, the engagement with diverse groups and reflection on our research practices will help the inclusivity of health innovations, and their evaluation. Further consideration on the implications of our findings, and actions that should be taken in future, around inequality in app use are covered in Chapter 9.