Do community-based digital health inclusion programmes contribute to tackling health inequalities in disadvantaged population groups?: a qualitative study of experiences of a city-wide programme in the North of England.

Background: Advances in digital healthcare and health information provide benefits to the public. However, lack of digital skills together with access, confidence, trust and motivation issues present seemingly insurmountable barriers for many. Such digital health exclusion exacerbates existing health inequalities experienced by older people, people with less income, less education or who don't have English as a first language. This study examines the role of a city-wide digital inclusion programme in the North of England, which works with Voluntary Sector Community Organisations (VCSOs) to provide digital support to disadvantaged communities (Digital Health Hubs). The aim was to explore if and how Digital Health Hubs contribute to tackling health inequalities, with a specific focus on impacts on service-users and how these impacts are produced.

Methods: We used qualitative semi-structured interviews to explore the experiences of service-users receiving digital support, and perspectives of staff working for organisations coordinating or providing digital support (n = 30).

Results: Inductive thematic analysis was used to identify four major themes and mapped to 'Consolidated Framework for Implementation Research' constructs. These were: programme components, recipient-centred support, impacts on service-users and system-level barriers to digital health services. Findings suggest moderators of implementation are provision of community spaces, social activities and devices and Wi-fi, and recipient-centred support through community understanding, personalised regular support and trusting relationships. Impacts on service-users include improved social and emotional resilience and basic digital skills. Health system-level barriers to digital health services, such as inconsistency in service provision, were also identified.

Conclusions: Themes highlight the importance of recipient-centred support by Voluntary and Community Sector Organisations (VCSOs) which centres the unique needs of specific communities. Our data provide policymakers with a model for implementation that could be replicated and scaled-up. Our data add to the public health, primary care and digital health research by proposing an initial programme theory for how Digital Health Hubs may reduce health inequalities, and recommendations for evaluation which consider short-, medium- and long-term outcomes, and contextual factors which are likely to be crucial to Digital Health Hubs' effectiveness.