Tackling the digital divide: evaluating and enhancing digital health intervention readiness amongst low-SES populations

数字卫生干预措施（DHIs）利用诸如移动电话、互联网、电视和环境传感器等数字技术来改变健康行为。发展卫生保健对改善健康的短期效益是公认的，而且往往被认为是大规模改善人口健康的一种具有成本效益的手段。然而，人们越来越认识到，数字技术会扩大而不是减少卫生不平等。本博士将调查DHI疗效的决定因素以及在服务不足人群中可以对其进行修改的程度。具体而言，这项工作旨在定义一个多维结构，以捕获一个人的“数字健康准备情况”，创建一个有效的工具来衡量它，并制定一个简短的干预措施来加强它。这项工作支持经济和社会研究理事会的目标，即探索公共卫生和行为，以保持人们的健康，特别关注贫困人口。研究方法和框架由于认识到影响健康行为的广泛环境和文化因素，将采用跨学科的方法，并由健康、社会学和心理学的同事监督。该研究将使用COM-B框架，承认行为是个人能力、机会和动机的结合。它将寻求回答以下研究问题：1。导致DHIs使用和受益不平等的社会心理机制是什么？是否可以开发一种新的多维尺度来评估这些机制并准确预测DHI准备情况？一个简短的“预干预”可以改善低社会经济地位DHI用户对体重相关行为的DHI准备吗？方法和研究设计将进行范围审查，以确定最相关的社会心理机制，这些机制是体重相关行为中数字鸿沟的基础。作为审查的一部分，将开发一个概念模型，列出可能预测或解释DHI疗效的关键组成部分（包括调节、中介和控制变量）（研究1）。利用这一模型，将使用最佳实践方法制定dhi准备程度量表。量表开发将包括三个阶段：[1]项目开发-使用在范围审查中确定的项目和由专家和用户评估的内容有效性；[2]量表开发-用探索性因子分析分析的结果测试精炼量表；项目难度、项目歧视、项目间和项目总体相关性也将被评估（研究2）；[3]量表评估-将进行验证性因子分析和其他统计测试，以测试模型拟合和量表项目的维度；将评估并发效度、建构效度和预测效度，以及重测信度（研究3）。接下来，将与用户和利益相关者共同制定“干预前”，以使用以人为本的方法提高潜在用户的dhi准备程度（研究4）。最后，将在一项试点随机对照试验中测试预干预的有效性，以评估DHI准备情况的改善，以及随后参与DHIs的效果（研究5）。影响：我们将与斯温顿自治市议会就该项目进行合作；现附上公共卫生署长的支持信。这项研究将产生学术影响，因为它提供了DHI效力决定因素的综合模型，以支持制定更好、更有效的干预措施，而不太可能扩大卫生不平等。它还将产生社会影响，将发展中国家保健服务的覆盖面扩大到服务不足的人口。这项研究的结果将通过研究摘要、同行评议出版物、社交媒体、讲习班和会议的组合传播给NHS、公共卫生主任、第三部门提供者和研究人员。

Digital health interventions (DHIs) utilise digital technologies such as mobile phones, the internet, television, and environmental sensors to modify health behaviours. The short-term benefits of DHIs for improving health are well established and they are often posited as a cost-effective means of improving population health at scale. However, there is increasing recognition that digital technologies can widen rather than reduce health inequalities. This PhD will investigate the determinants of DHI efficacy and the extent to which they can be modified in underserved populations. Specifically, the work seeks to define a multidimensional construct that captures one's 'digital health readiness', create a valid instrument to measure it, and develop a brief intervention to enhance it. This work supports the Economic and Social Research Council aim of exploring public health and behaviour to keep people healthy, with a particular focus on deprived populations.Research approach & frameworksIn recognition of the broad range of environmental and cultural factors that influence health behaviours, an interdisciplinary approach will be adopted with supervision from colleagues in health, sociology, and psychology. The research will be framed using the COM-B framework, accepting that behaviour is a combination of individual capability, opportunities and motivation. It will seek to answer the following research questions:1. What are the psychosocial mechanisms that underpin inequalities of use and benefit in DHIs?2. Can a new multidimensional scale that evaluates the these mechanisms and accurately predicts DHI readiness be developed?3. Can a brief 'pre-intervention' improve DHI readiness for lower-SES DHI users applied to weight-related behaviours?Methodologies and study designA scoping review will be conducted to identify the most pertinent psychosocial mechanisms that underpin the digital divide in weight-related behaviours. As part of the review, a conceptual model will be developed setting out the key components (including moderating, mediating and control variables) likely to predict or explain DHI efficacy (study 1). Using this model, a DHI-readiness scale will be developed using best practice methodologies. Scale development will comprise three phases: [1] Item development - using items identified in the scoping review and content validity assessed by both experts and users; [2] Scale development - testing the refined scale with results analysed using Exploratory Factor Analysis; item difficulty, item discrimination, and inter-item and item-total correlations will also be assessed (study 2); and, [3] Scale evaluation - Confirmatory Factor Analysis and other statistical tests will be conducted to test model fit and the dimensionality of the scale items; concurrent, construct and predictive validity, as well as test-retest reliability will be assessed (study 3). Next, a 'pre-intervention' will be co-produced with users and stakeholders to improve DHI-readiness in prospective users using a person-based approach (study 4). Finally, the efficacy of the pre-intervention will be tested in a pilot randomised controlled trial to assess improvements in DHI readiness, and subsequent engagement with, and efficacy of, DHIs (study 5). ImpactWe will collaborate on the project with Swindon Borough Council; a letter of support is attached from the Director of Public Health is available. The research will have academic impact by providing a comprehensive model of the determinants of DHI efficacy to support the development of better, more effective interventions less likely to widen health inequalities. It will also have societal impact by broadening the reach of DHIs to underserved populations. The findings of this research will be disseminated to the NHS, Directors of Public Health, third sector providers and researchers through a combination of research digests, peer-review publications, social media, workshops, and conferences.