Healthcare professionals' attitudes towards digital health interventions and perspectives on digital health inequalities: a qualitative study

Background: Use of Digital Health Interventions (DHIs) for the management of cardiometabolic diseases has increased, but may exacerbate existing health inequalities. Healthcare professionals (HCPs) play a vital role in recommending and supporting patients to use these tools. There is a need to understand the role of HCPs in managing the implementation of digital health in communities at risk of health inequalities. Objective: To explore the views of health care professionals about digital health and its impact on health inequalities, focusing on cardiometabolic diseases and the South Asian population in the UK. Methods: Online interviews and focus-groups with HCPs (n=18), exploring participants' experiences and attitudes towards digital health, perceptions of patients' barriers and facilitators to use, whether they perceived any populations to be particularly at risk of digital inequalities, and the impact of the COVID-19 pandemic on their practice in relation to digital health. After informed consent, transcription and coding, a reflexive thematic approach was taken to analysis. Results: HCPs recognised the potential benefits of DHIs to improve access and delivery of care and patient outcomes, but described several barriers to successful implementation. HCPs demonstrated a good understanding of the challenges their patients face in relation to wider inequalities, barriers to health behaviours and healthcare access, and digital health. Of particular concern was the impact of increasing reliance of digital interventions in health care on the exclusion of some patient groups. Participants recommended improvement of the design and implementation of DHIs offered to patients through working with at-risk populations throughout the process. Finally, participants emphasised the importance of ensuring non-digital services remained available to ensure equitable access to health and social care. Conclusions: HCPs described the complexities of delivering care to underserved communities. DHIs were identified as a potential way to improve health outcomes for some, while over-reliance risked exacerbating inequalities. Participant recommendations related to design, implementation, and engaging target populations providing practical examples to address digital health inequalities, such as working with other sectors to take a community approach.