The benefits of digital health tools for supporting self-management of health conditions and access to services are well-documented: eliminating the need to travel to appointments, providing information and reminders, reducing the workload for healthcare professionals and more. For older adults, these benefits of digital health are no less relevant. Especially in the case of musculoskeletal (MSK) injuries, digital triage and treatment programmes have shown to be effective and to provide a welcome alternative to long waits for in-person treatment options.
As a physiotherapist, I found that patients generally wanted to be in control of their own treatment and recovery process, and that digital tools provide a unique avenue for delivering this control. This attitude does not change as patients get older. In fact, because older adults often struggle with feeling disempowered in an increasingly online, tech-mediated world, they appreciate opportunities to engage successfully with digital tools more so than younger people do. Some of the most positive feedback that we receive about Phio, EQL’s digital musculoskeletal healthcare platform, has come from users aged 70 and older.
I believe that it’s the joint responsibility of healthcare organisations and healthtech providers to facilitate equal access to the advantages of digitally-mediated care, and that this can be achieved through a strategy that prioritises communication, trust-building, and age-aware service and product design.
What barriers exist for older adults accessing digital health tools?
I was recently part of a research team for a focus group study exploring perceptions of using digital health platforms, now published in JMIR Aging, for which older adults were asked their opinions on the use of such platforms for supporting the self-management of muscle and joint conditions.
Despite the growing use of digital platforms for health management, particularly since the COVID-19 pandemic, the responses revealed significant concerns among older adults about replacing face-to-face consultations with technology. Participants cited a lack of trust in digital platforms’ ability to accurately diagnose conditions effectively without in-person oversight.
Specifically, scepticism was voiced about the accuracy and safety of digital health platforms, with some worrying that serious conditions could be overlooked without in-person assessments:
“What you can never get from an app is the face to face, because quite often when people go to the doctor with one thing, the doctor looking at them see’s something else that they hadn’t sometimes realised themselves….So this is why I think face to face with always remain a crucial part of the you know, welfare of human being.” (focus group participant).
Participants further cited concerns toward carrying out physiotherapy exercises without physical observation or input from an in-person physiotherapist. One of the participants explained how following a hospital appointment, they had been given physiotherapy exercises to complete (the exercises were described on a sheet of paper). They described how they realised they were carrying out the exercises incorrectly only after a family member had observed them.
Issues around the legitimacy of some health apps were highlighted. Participants expressed concerns about not knowing whether apps are real or fake, and concern about clicking links that took them to third-party websites or asked them to download materials onto their devices. They were also concerned about sharing personal information with unknown third-party provider
The common denominator to these barriers is trust: the patient’s trust in themselves to use the tool correctly, the trust that they’ll be receiving the best care, and the trust in the technology provider.
How can this trust be created and maintained?
In order to feel comfortable using a tool independently, a user must have trust in themselves to understand how to use and navigate it in the correct way. This is an essential first step towards benefiting from the technology, and has two parts. Firstly, the user must receive clear instructions and training on how to use the tool, and secondly, the tool must be designed in a way that is accessible and intuitive. When delivering training and designing the interface, providers should be aware that older adults have vastly different levels of digital literacy and digital support from family members. So, testing and consulting with as many different people is essential in the development and implementation phase.
To ensure that the users gain trust in the efficacy and quality of the tech tool – and in the treatment it delivers – users need to be made aware of the standards and regulations that are upheld by approved healthtech tools. This could be achieved via a targeted communications campaign that makes the public aware of the official bodies that vet third party technology providers – such as ORCHA – and how they can check the credentials of these technologies themselves. Concurrently, healthcare providers should take responsibility for communicating the efficacy and impact of digital health tools – publicising user case studies and success data, for example – so users understand why they are being asked to use them and the benefits of doing so.
By Peter Grinbergs, co-founder and Chief Medical Officer at EQL