Experiences and views of older adults of South Asian and Black African or Caribbean background about digitalisation of primary care services since the COVID-19 pandemic: Qualitative Focus Group Study (Preprint)

Abstract

The COVID-19 pandemic of 2020-2022 prompted governments worldwide to enforce lockdowns and social restrictions, alongside the rapid adoption of digital health and care services. However, there are concerns about the potential exclusion of older adults, who face significant barriers to digital inclusion, such as age, socioeconomic status, literacy levels, and ethnicity.

This study explored the experiences of older adults from the two largest minoritised ethnic groups in England and Wales, South Asian and Black African or Caribbean backgrounds, in the use of digitalised primary care services since the beginning of the pandemic.

Twenty-seven individuals participated in four focus groups (April and May 2023), either in-person or via online video conferencing. Patient and public involvement and engagement (PPIE) were sought through collaboration with community organisations for focus group recruitment and feedback on the topic guide. Data were analysed using framework analysis.

This paper summarises the perspectives of 27 older adults from these two minoritised ethnic groups and identifies four key themes. Theme 1: Service accessibility through digital health: Participants faced difficulties accessing digital health care services online, primarily due to language barriers and limited digital skills, with reliance on younger family members or community organisations for assistance. The lack of digital literacy among older community members was a prominent concern, and digital health care services were felt to be tailored for English speakers, with minimal consultation during the development phase. Theme 2: Importance of in-person face-to-face appointments for patient-clinician interactions: In-person appointments were strongly preferred, emphasising the value of physical interaction and connection with healthcare professionals. Video consultations were seen as an acceptable alternative. Theme 3: Stressors caused by the shift to remote access: The transition to remote digital access caused stress, fear, and anxiety. Participants felt that digital health solutions were imposed without sufficient explanation or consent. Black African Caribbean participants reported experiences of racial discrimination within the health care system. Theme 4: Digital is here to stay, but one size does not fit all: Participants acknowledged the importance of digitalisation but cautioned against viewing it as a one-size-fits-all solution. They advocated for offline alternatives and a hybrid approach, emphasising the need for choice and a well-staffed clinical workforce.

Digital health initiatives should address the digital divide, health inequalities, and the specific challenges faced by older adults, particularly those from minoritised ethnic backgrounds, ensuring accessibility, choice, and privacy. Overcoming language barriers involves more than mere translation. Maintaining in-person options for consultations, addressing sensitive issues, and implementing support systems at the practice level to support those struggling to access services are vital. This study recommends that policymakers ensure the inclusivity of older adults from diverse backgrounds in the design and implementation of digital health and social care services.

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