The Digital Inclusion Framework (DIF) for Health and Care
A thinking tool and implementation tool designed to ensure that everyone can benefit from digital health and care, whenever they need to, thereby reducing digital exclusion and the associated health inequalities.
To be digitally included for health and care, individuals need to:
Know about digital health and care services, pathways, applications, and technologies that can benefit them.
Have access to and be able to afford the necessary technology and associated requirements (e.g. data, smartphone).
Have the skills and support (either informal or formal) to optimally use the technologies/pathways.
Believe that the effort to engage will be worthwhile, (recognising some people will have more barriers than others to overcome).
Trust that the services, pathways, and technologies are safe and effective, and their data is safe too.
Be able to access and use pathways, services, and technologies because they are easy to understand and are user-friendly, whatever their needs.
Have confidence in receiving appropriate guidance and support when needed.
Enablers and facilitators of digital inclusion
Meet Fred
Fred is 80 years old, he relies solely on the state pension and he is in declining health. Fred has Chronic Obstructive Pulmonary Disease (COPD), hypertension, a tremor, and has had a few falls lately. He currently has a COPD exacerbation that could potentially be managed on the virtual ward.
To fully benefit from digital health and care, Fred will need a digital device and internet, and will typically need to navigate:
GP website (to book an appointment)
Online consultation platform (for an appointment with GP)
NHS app (to order repeat prescriptions)
My health and care record (to receive letters and results)
Text messages, a blood pressure monitor to record his own blood pressure, and the confidence, literacy, numeracy, and dexterity to upload his results
An app for managing his COPD
A different app for strength and balance support and exercise
A different blood pressure, oxygen saturation monitor, and virtual consultation platform for virtual wards.
The Digital Inclusion Framework for Health and Care acknowledges that digital inclusion is a not a static state and individuals can face exclusion at various stages of their journey with digital health and care pathways, services, and technologies.
The framework and implementation tools can be used:
to assess the inclusivity of current digital health and care pathways, services and technologies,
to design new inclusive pathways, services and technologies, and
to inform digital inclusion policy, strategy, programmes and pathways.
THE CORE VERSION OF THE FRAMEWORK provides an overview of the enablers and facilitators of digital inclusion on every stage of the digital health service user journey.
THE EXTENDED AND INTERACTIVE VERSION of the framework includes the recommendations for mitigating against each digital inclusion barrier.
THE ASSESSMENT TOOL supports the practical application of digital inclusion framework in the context of designing and reviewing digital services and pathways.
How was Digital Inclusion Framework developed?
We conducted an integrative review of barriers and enablers to digital inclusion captured in academic research, national reports and local and national evaluations of digital health inclusion-related pilots and programs.
A working version of the framework was tested, further developed and validated with various NHS Sussex collaborators including clinicians, support workers, digital teams, commissioners, patient representatives and experts on digital inclusion and accessibility topics.
The framework emerged out of the collaboration between University of Sussex and NHS Sussex, supported by the Health Innovation Kent Surrey Sussex.
Prof. Debbie Keeling and Dr Maja Golf-Papez have led on the research element of the framework in collaboration with Dr Jessica Hadjis van Thiel, Dr Ralitsa Hiteva and Nora Davies from the University of Sussex.
Katherine Sykes from Health Innovation Kent Surrey Sussex led on the health and care elements, including the application of relevant research and policy for health and care, and ensuring key stakeholder involvement in the development of the framework.
Stakeholders from across NHS Sussex were actively involved in the development of the framework through various workshops, consultation, and public engagement.