Bringing health to patients not the other way around
15 months into the NHS Widening Digital Participation (phase 2) programme and we are refining how we articulate the health benefits of digital for those who are most excluded.
At Good Things Foundation we have the privilege of working with a lot of heroes across 3 different continents, all of whom use digital to help the most excluded in society have better lives. The Widening Digital Participation programme seeks to find ways that digital can benefit the health of excluded groups in England.
If you are reading this then you are probably already digitally savvy and as such will be benefitting from things like cheaper car insurance, connection with overseas relatives, being able to answer any question in a pub that anyone has ever asked etc etc! But imagine the problems in trying to explain digital to someone who is excluded…. what do you say? Then imagine trying to tie this back to health…. it can get messy.
We found, during our Sheffield Pathfinder, that mentioning ‘digital’ to patients creates a barrier. They perceive it as the addition of an extra hurdle before they feel better — and the more hurdles they see the more chance that it will feel unobtainable; leading to drop out. By removing the word ‘digital’ (I have some issues with our industry not being able to define what this exactly means, but that is for another day) we were able to engage people in their own health and increase their willingness to make positive lifestyle changes. Digital facilitated aspects of this but there was never a need to mention it.
Go where the people are.
We have been saying “go where the people are” throughout this programme and this mantra has helped for co-design e.g. our work in Hastings with the homeless community. However, my recent trip to Stoke has made me think we haven’t took this far enough.
Take health to people….
We have been trying 3 intervention models in Stoke to engage people in different aspects of their health. And the over arching theme is about taking health to people — where they are, both digitally and physically.
As with all the best things to learn, it’s kinda obvious when you look back but this method of reaching people is having some incredible impact. Our findings are that, for an excluded individual, public body structures and facilities can be too daunting to interact with and consequently the first point of engagement should be on the individuals terms.
Model 1 — Closed facebook groups for Long Term Conditions
I’ve written in the past about being part of a closed facebook group and how it uses invaluable peer support (at the moment it’s needed)coupled with almost immediate access to health professionals. Add to this;
- If you are using facebook habitually, for social reasons, then there is a convenience to getting notifications from the Long Term Condition group. You can flit in and out of conversations, add your bit and get other’s support in a way works around your other digital activities. Contrast this to using more structured and historical chat forums that need a separate log in and need considerable actions to access. The closed facebook groups are driving more active participants
I couldn’t live without this — Patient with MS using the closed group
Model 2 — Screening services having a Facebook presence
The Breast Cancer Screening team around Stoke have been spending time advertising their services on Facebook. They are posting on community groups and finding out where their demographic audience ‘hangout’ on facebook. This approach means;
- The barrier to entry for screening is lowered. The people that are being engaged don’t have to leave their current activity, go to another place (different site) or use another medium to book an appointment.
- A phone call immediately afterwards from a friendly person helps solidify the appointment — instead of just an anonymous letter being sent which inevitably ends up in a drawer somewhere
- Posting videos about what to expect and using peer case studies helps to reassure people.
This has seen a 6% increase in uptake across Stoke (contrasted with a 4% decreasing national trend) and a 13% uptake in 2 targeted areas of exclusion.
The approach has been published in the British Journal of General Practice.
Model 3 — Taking digital inclusion to the people
The pathfinder in Stoke has been using a terrific organisation called Wavemaker for the digital inclusion work. They have been facilitating some incredible sessions in community centres and practices in Stoke. As great as those sessions have been the take up hasn’t been particularly great. To try something different Wavemaker have been taking a kitted out van to various places and providing some digital health activity where people are. We believe that the success of this approach lies in the following
- Providing quick health checks and kit is a good way to engage people. Wavemaker (with Stoke CCG) have been measuring people’s heart age. This has allowed for further conversations about digital and health.
- Free stuff (mostly cake) helps. People are interested and like to talk over food. Don’t pressure them but allow the free stuff to bring them over.
- Supermarkets (and places like this) are touch points that all of us have. They are non threatening and don’t carry the power dysfunctions of a GP practice, this helps excluded individuals explore something at their leisure.
The Tesco car park day with Wavemaker resulted in 100+ conversations, 55 heart checks and who knows how much cake eaten. Compare this to the 4’s and 5’s that have attended the sessions that have been advertised and we are really onto something.
Over the summer we will be evaluating the nuts and bolts of the impact of these models in the hope that the bits that work can be spread in other areas of the country.
If you want to get involved or learn more have a look at our Digital Health Labor contact me firstname.lastname@example.org