A digital inclusion intervention to improve access to a digital health intervention among digitally excluded adults: a mixed methods pilot study

Background:

The NHS 10 Year Health Plan emphasises an increasing shift towards digital healthcare delivery. However, there is limited research on how best to support, engage, and include individuals who are digitally excluded. As healthcare services become more digitally driven, evidence-based interventions are needed to address digital exclusion and ensure equitable access to care, particularly for people living with long-term conditions.

Objective:

This study aimed to evaluate the feasibility and acceptability of providing digital literacy training alongside a digital health intervention (DHI), compared with a DHI alone. Kidney Beam, a DHI designed to promote physical activity and improve quality of life in people living with chronic kidney disease (CKD), was used as an exemplar intervention.

Methods:

A mixed-methods, single-site pilot randomised controlled trial recruited 40 adults with CKD who were digitally excluded. Digital exclusion was defined as lacking access to a Wi-Fi–enabled digital device or scoring <7 on a Digital Health Literacy Screening tool (DHLS). Participants were randomised 1:1 to receive either the Ex-Tab digital inclusion intervention alongside Kidney Beam or Kidney Beam alone. Participants in the intervention group received a Wi-Fi–enabled iPad with Kidney Beam pre-installed, digital literacy training, and ongoing support to access the 12-week Kidney Beam programme, which included twice-weekly live exercise and education sessions. The control group received sign-up instructions for Kidney Beam only. Feasibility outcomes were assessed against a priori progression criteria and included screening, recruitment, retention, adherence, safety, and acceptability. Secondary outcomes included the Kidney Disease Quality of Life questionnaire, Chalder Fatigue Questionnaire, and Patient Health Questionnaire-4 (PHQ-4). Outcomes were measured at baseline and 12 weeks. Acceptability and user experience were explored through semi-structured interviews with participants from both groups at 12 weeks (n=25).

Results:

Between September 2023 and September 2024, 169 individuals were screened and 40 enrolled (median age 66.5 years; 50% male; median DHLS score 4). Twenty-one participants were randomised to the Ex-Tab group and 19 to the control group. Thirty-five participants (88%) completed the 12-week follow-up (Ex-Tab n=18; control n=17). All pre-specified feasibility criteria for recruitment, retention, adherence, and safety were met. Qualitative findings indicated that the tablet loan and digital literacy training were acceptable and highly valued, enhancing confidence, motivation, and engagement with the DHI. Providing loaned devices was particularly important for overcoming access barriers, especially for participants unable to afford their own.

Conclusions:

Providing Wi-Fi–enabled devices and digital literacy training alongside a DHI was feasible and acceptable for people with lower levels of digital literacy. Findings support progression to a future definitive multicentre trial or implementation study and offer transferable insights for the design of digital inclusion strategies across other long-term health conditions. Clinical Trial: The study was approved by the Bromley NHS Research Ethics Committee (Ref: 21/LO/0243) and registered on ClinicalTrials.gov (NCT04872933).