Off line or frozen out?
Accelerated by COVID, the use of digital technology is growing exponentially and many of us are reaping the incredible benefits of connecting and communicating online.
But spare a thought for those who either aren’t connected or aren’t supported by our growing digital world – those who are digitally excluded.
The term digital exclusion has been gathering pace in recent years. Commonly considered to arise through lack of kit, digital capability or connectivity, around 10% of adults in England are digitally excluded and older people are disproportionately affected.
Although growing numbers of older people are using the internet, a large proportion – around 36% – remain disconnected. In 2018, Age UK estimated that around 4.2 million of those aged over 65 were either offline, lapsed or had never used the internet.
Reasons for digital exclusion
Much of the national debate around digital exclusion assumes that technical solutions such as skilling up or widening access to low cost kit and data will solve the problem. In reality however, exclusion often arises for more complex health and social reasons and older people are more likely to face multiple disadvantages.
Health related barriers such as dementia, sight and hearing difficulties are especially common amongst older age groups with profound implications for their ability to navigate digital products and services.
Older people are also more likely to experience major social barriers such as financial pressures or social isolation.
Other social barriers also shape how likely individuals are to embrace the digital shift. These relate to the ideas, concerns and expectations individuals have about the products and services they need to access and the extent to which they view digitalisation favourably. Common concerns relate to issues like confidence, trust, privacy, autonomy and safety. These concerns can both exacerbate, or be compounded by, mental health problems such as anxiety.
Enabling digital inclusion
We believe that more powerful conversations and solutions could be achieved by shifting the debate away from digital exclusion towards digital inclusion.
By focusing on an inclusion agenda, we can move conversations away from technology towards human and social factors and the importance of meeting the needs of vulnerable groups.
The value of focusing on inclusion is well illustrated by recent work around inclusive health care from National Voices. The COVID-19 pandemic rapidly and dramatically changed the way we accessed health services with many switching to remote access. This shift prompted the coalition of health and social care charities in England to undertake a detailed listening exercise to fully understand the implications.
Patient experience in remote care
The listening exercise found that remote health care does not always provide a positive experience of care with negative implications for service quality. Issues like effectiveness, efficiency, access, equity and user satisfaction can all be negatively impacted especially for those who are more vulnerable.
Although respondents recognised the value and rationale underpinning remote working and could identify the advantages, many explained how they struggled with the new arrangements.
The reported struggles included getting muddled or stressed about doing new tasks such as completing online forms or accessing and installing apps. There were also concerns relating to telephone call back appointment systems which made it difficult for some users to feel in control, others to communicate effectively, and others to gather their thoughts and express themselves adequately.
Carent involvement is vital
The exercise also revealed how many respondents rely on others for support with access and equipment.
This finding will come as no surprise to carents who are increasingly finding themselves acting as remote service advocates and translators and in house IT advisers and engineers.
Interestingly there seems to be little research about the impact of remote care on carers or carents. Remote care might actually be more time consuming for carents than face to face care because of all the IT support they need to provide and the use of “call back” arrangements.
As well as overcoming technology and software challenges, carents and carers are now providing the access, championing and communication support which was once delivered by clinic nurses and reception staff. Also, whereas previously it was possible to schedule time to accompany a loved one to an appointment, nowadays it is more difficult to organise time to accommodate an unspecified “call back”.
Bridging the digital divide for inclusive ageing
Remote health care, banking and other essential services are here to stay but we need to find new ways of providing these services to deliver positive outcomes for everyone.
Access and user experience are key drivers of service quality which we need to recognise and address as part of the debate around digital exclusion and remote services.
Proactively adopting inclusive innovation and design principles could help to ensure older people, carents, carers and other vulnerable groups can continue to thrive in our digital world.
