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

数字健康干预（DHIs）利用数字技术，如移动的电话，互联网，电视和环境传感器来改变健康行为。DHIs对改善健康的短期效益是公认的，它们通常被认为是大规模改善人口健康的具有成本效益的手段。然而，人们越来越认识到，数字技术可能会扩大而不是减少健康不平等。这个博士将调查DHI疗效的决定因素，以及它们在服务不足的人群中可以被修改的程度。具体来说，这项工作旨在定义一个多维度的结构，捕捉一个人的"数字健康准备"，创造一个有效的工具来衡量它，并制定一个简短的干预措施，以加强它。这项工作支持经济和社会研究理事会的目标，探索公共卫生和行为，以保持人们的健康，研究方法和框架认识到影响健康行为的各种环境和文化因素，在卫生，社会学和心理学的指导下，将采用跨学科的方法。该研究将使用COM-B框架进行框架设计，承认行为是个人能力、机会和动机的结合。它将试图回答以下研究问题：1。什么心理社会机制是造成保健机构使用和受益不平等的基础？2.能否开发一种新的多维度量表来评估这些机制并准确预测DHI准备情况？3.一个简短的"预干预"可以提高DHI准备低SES DHI用户适用于体重相关的行为？方法和研究设计将进行范围审查，以确定最相关的心理社会机制，支持与体重有关的行为的数字鸿沟。作为审查的一部分，将制定一个概念模型，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）。利用这一模式，将采用最佳做法方法制定一个人道主义行动准备程度表。量表编制将包括三个阶段：[1]项目编制-使用专家和用户评估的范围审查和内容有效性中确定的项目;[2]量表编制-使用探索性因素分析对结果进行测试;还将评估项目难度、项目区分度以及项目间和项目-总相关性（研究2）;以及[3]量表评估-将进行验证性因素分析和其他统计检验，以检验模型拟合和量表项目的维度;将评估同时效度、结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作"干预前"，以使用基于个人的方法提高潜在用户的DHI准备程度（研究4）。最后，将在一项初步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DHI的后续参与和有效性（研究5）。影响我们将与斯温登自治市理事会合作开展该项目;随附公共卫生署署长的支持信。该研究将通过提供DHI功效决定因素的综合模型来产生学术影响，以支持开发更好，更有效的干预措施，不太可能扩大健康不平等。它还将通过扩大保健机构对得不到充分服务的人口的覆盖范围而产生社会影响。这项研究的结果将通过研究专家、同行评议出版物、社交媒体、研讨会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.