Digital technology is, for many people, an inherent part of everyday life. People’s ability to use, their extent of access to, and their engagement with, digital technology has the potential to impact almost every facet of daily life including one’s health. Digital health technologies (a subset of digital technologies) are primarily concerned with health, wellbeing, and the delivery of health services, and include personal devices, software, and online services. Digitally-enabled approaches to health, healthcare, and wider public services have become increasingly common. The COVID-19 pandemic accelerated the use of digital technology, as seen for example through the offer of virtual services as a replacement for in-person services, and through changes in the delivery of health promotion initiatives.
There is a growing body of research cautioning that digital technologies will exacerbate and/or create health inequalities. The rapid development and application of artificial intelligence (AI), given its perceived potential to enhance the performance of digital technologies, is also likely to have implications for health inequalities – in both a positive and negative sense. One concern is that health inequalities may become entrenched through development of AI models that are trained using existing biased data sets.
The literature, including a scoping review by Public Health Wales NHS Trust, describes access, digital literacy, and engagement (recent research by the Good Things Foundation expands these domains) as three key factors determining digital inclusion or exclusion. Digital inclusion itself can be considered to be a wider determinant of health.
There is a paucity of evidence, however, on the impact of the societal shift towards a focus on digital technologies, and how different people experience exclusion unevenly (leading to the ‘digital divide’) for example due to intersecting identities, or how to mitigate such inequalities. Groups at risk of digital exclusion include rural communities, older adults, people from ethnic minority backgrounds, people experiencing deprivation, and others.
The PHR Programme recognises that this topic area would benefit from some underpinning development work in advance of a funding call seeking evaluative research of interventions addressing digital health inclusion and health inequalities.
Awards made under this ADA opportunity will be between £50,000 and £150,000, over a maximum period of 12 months. The aim of this ADA is to provide funding for underpinning development work that adds to the current and emerging knowledge base and supports a future application for evaluative research.
Potential areas of work for this ADA include (but are not limited to):
- Underpinning work on existing digital inclusion approaches, to understand which outcome measures could best be used for a study investigating effectiveness of interventions that seek to mitigate digital exclusion.
- Work to develop research methodologies or approaches for evaluating interventions related to digital technology and their impacts on health outcomes.
- Work to advance epidemiology relating to the distributive impacts of digital exclusion. Particular emphasis could be placed on the scale, types, and pattern of health impacts, including, for example, variations based on geography, ethnicity, gender, socio-economic status, disability, long-term conditions, and age.
- Engagement with, and mapping of, stakeholders and networks working in this space, including the development of new networks or partnerships to support future interventional research. Stakeholders might include organisations in the voluntary and community sectors, as well as academic researchers, and others.
- Scoping work on the application of digital technologies during the COVID-19 pandemic, including consequences that resulted, and lessons learned.
- Work to advance knowledge conceptualising how digital exclusion comes about, the barriers experienced, and how exclusion can be addressed; this work may include theory of change models. The domains of access, literacy, and engagement – and others – may form part of such work.
- Underpinning work on co-production and public involvement in the development, roll-out, and ongoing improvements of digital technologies – in particular that relate to mitigation of the impacts of exclusion.
- Scoping work related to AI will be considered for funding via this ADA. However, applicants are reminded that a future research proposal resulting from this ADA will need to comprise evaluative research of an intervention – applicants should clearly describe how work into AI undertaken via this ADA will inform the future proposal.
Applicants should note that:
- The PHR Programme will consider funding more than one study team for this ADA. Successful teams are not expected to undertake work on all aspects identified above and can focus on a single element, as preferred.
- For interventional research that builds on work funded by this ADA, the PHR Programme will only fund research that has health-related primary outcomes. It will accept other outcomes provided the link to health can be justified. The remit of the PHR Programme is to generate evidence to inform non-NHS interventions.
- The PHR Programme welcomes applications from inter-disciplinary teams.
- The PHR Programme will not fund the creation of mobile applications (apps) through this ADA.
Applicants to this ADA should ensure that their proposed work demonstrates a clear link to future possible evaluative research into interventions that address digital health inclusion and inequalities. The PHR programme will be interested primarily in population-level rather than individual-level interventions, and in interventions that address health inequalities and the underlying wider determinants of health.
The PHR Programme recognises that interventions are likely to impact different (sub)populations in different ways and encourages researchers to explore such inequalities of impact in their study design. Of particular importance to the PHR Programme is an understanding of inequalities in impact of policy and access to services by people from ethnic minority backgrounds in the UK. Evaluations of interventions seeking to reduce health inequalities experienced by people from ethnic minority backgrounds are also of specific interest to the PHR Programme.
Research teams who feel they are already in a position to submit a proposal to evaluate interventions relating to digital health inclusion and inequalities are welcome to do so directly via the Researcher-led workstream.
If you have specific questions about this funding opportunity, please contact: phr@nihr.ac.uk
Timescales
Commensurate with the level of funding available for this ADA, this is a direct-to-Stage 2 funding opportunity. Applications will be assessed by a sub-committee of the PHR Programme Prioritisation and Funding Committee. Applications will be assessed for importance to public health, scientific quality, feasibility, and value for money. Successful applicants will be expected to begin the work within four months of the funding decision being communicated.
Successful applicants will be expected to produce a 3,000-8,000-word article for the NIHR Journals Library. Any other outputs must be accessible in line with NIHR’s Open Access policy.