2 Conceptualising trust in video consultations

Journal article

The rapid digitalisation of healthcare services has led to the widespread adoption of remote consultations, particularly in the wake of the COVID-19 pandemic. While these digital health technologies have the potential to increase access to care, the benefits are not always equally distributed. This study aims to address the significant gaps in understanding the intersectionality of factors contributing to digital health disparities and their impact on patients’ lived experiences. The research question guiding this study is: How do multiple types of disadvantage intersect to contribute to digital health disparities in the uptake of remote consultations? The study employs an intersectional approach, examining the complex ways in which the intersection of age, income and limited English proficiency affects patient experiences with video consultations and digitalisation of health services. The theoretical frameworks of intersectionality, digital capital, and critical race theory provide a comprehensive lens for analysing the interlocking systems of oppression and inequities embedded within the structures and practices surrounding remote care. Methodologically, a qualitative narrative inquiry approach is employed to centre the voices and lived experiences of disadvantaged patients. Analysis showed that remote consultations can exacerbate existing inequities, erode trust, compound oppression, and reduce patient agency for multiply-disadvantaged patient populations. Key themes included: weakened presence in video consultations, erosion of therapeutic relationships, disruption of continuity, increased complexity leading to disorientation, and engagement shaped by prior experiences of discrimination. Participants reported feeling overwhelmed, disconnected, and disempowered by remote care services. The study's outputs include narrative portraits and user personas, fictional cases based on empirical data that draw together and illustrate the multiple intersecting elements of disadvantage. These portraits and personas capture the variety and complexity of how dimensions of disadvantage intersect and influence identity and actions, highlighting the challenges faced by older patients with multiple markers of disadvantage in accessing and receiving care through remote modalities like video consultations. This study provides critical insights into how the digitalisation of healthcare can deepen disparities for older, low-income, limited English speaking individuals. Findings underscore the need for intersectional approaches to digital health equity that address the multifaceted nature of disadvantage. Recommendations include co-designing inclusive digital services, strengthening relational continuity, and developing targeted support to preserve agency and trust for marginalised groups in an increasingly digital healthcare landscape

Authors: Seuren, L; Shaw, S; Pope, C; Greenhalgh, T

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ Publishing Group
• Journal: BMJ Open
• Volume: 11
• Issue: Suppl 1
• Pages: A15.1-A15
• Publication date: 2021-03-16
• DOI: 10.1136/bmjopen-2021-qhrn.40
• EISSN: 2044-6055
• ISSN: 2044-6055
• Language: English
• Keywords: Computer science