A realist synthesis and evaluation of digital health technologies: understanding inequalities for coeliac disease healthcare

Thesis

The aim of this research was to develop an understanding around the impact coeliac disease (CD) digital health technologies (DHTs) have on health inequalities.

Access and use of DHTs, and its impact on health inequalities is complex, thus developing an understanding of the ways in which CD DHTs might work (or not work) plus their differential impacts is essential. Accordingly, this thesis employed a realist methodology, an approach well-suited to making sense of complexity, in the form of a realist synthesis and realist evaluation.

The realist synthesis resulted in an Initial Programme Theory (IPT) which presented theoretical explanations around how CD DHTs work (or not). This synthesis revealed a selection bias around the over-inclusion of the least disadvantaged participants and thus evidence gaps around how CD DHTs work for seldom-heard groups.

To address this evidence gap, the realist evaluation purposively recruited focus group and interview participants with CD who also had either; coexisting conditions, digital exclusion, were from minority ethnic communities, from high deprivation postcodes and/or had experience of using a CD DHT. Data analysis enabled testing of each element of the IPT, resulting in a Programme Theory.

This thesis provides a novel and important understanding of why and for whom CD DHTs work. It demonstrates that the aforementioned sociodemographic characteristics may not be useful predictors for whom CD DHTs will, or won’t, work. Instead, through applying the characteristics of innovations from the Diffusion of Innovation Theory, the characteristics of compatibility, complexity and relative advantage may be more useful determinants of whether a CD DHT will be accessed and used.

This thesis presents a series of evidence-based recommendations for CD DHT design and implementation to reduce health inequalities. These findings and recommendations may be applicable to reduce inequalities in digital healthcare for other chronic disease areas. These findings should be of value to decision-makers and practitioners who are striving to improve CD healthcare whilst reducing inequalities.

Authors: Cooper, R

• DOI: 10.5287/ora-jbp8on8bd
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: realist evaluation; digital healthcare; coeliac disease; digital healthcare technologies; health inequalities
• Subjects: Public health; Health