Dr Marzena Nieroda, an expert in healthcare marketing and commercialisation, talks to Health Tech World about making health tech more accessible and inclusive.
Technological innovations are making healthcare more accessible than ever.
However, barriers remain between digital health tools and vulnerable groups such as older people, those from minority backgrounds and refugees.
Digital technologies include smart devices and connected equipment that improve health.
They include artificial intelligence, digital platforms, software, wearable devices and tools that capture and share health data across systems.
These technologies have been shown to support health workers and improve diagnosis, treatment and quality of care, but some are being left behind.
According to the GoodThings Foundation, 12.6 million people in the UK lack basic digital skills while 5.3 million have never been online before.
A WHO/Europe study published in late 2022 found that digital health technologies are not equally accessible to all communities and areas in Europe.
The research, based on evidence from 2016 to 2022, showed that people with poor health are among those struggling the most in accessing these tools.
It also highlighted that there is more usage of health technology among people with a strong education and in urban areas.
Meanwhile, there is less usage by people from ethnic minorities, those facing language barriers, older generations and people from lower socio-economic backgrounds.
“These findings are important because they send a warning signal. Although we know that digital tools can go a long way in improving people’s access to health and health workers’ ability to care for people, we are now finding that the tools are not available to everyone equally, especially to people with underlying health conditions,” regional adviser on data and digital health at WHO/Europe, Dr David Novillo-Ortiz said in a statement.
“We need a better understanding of why this inequity persists and how we can improve people’s ability to access, use and engage with digital health tools.
“That is the only way we can truly leverage the power of digital solutions so that a more equitable future for digital health can be developed, ensuring no one is left behind.”
Dr Marzena Nieroda, assistant professor of marketing and commercialisation for healthcare at the UCL Global Business School for Health, is dedicated to addressing these challenges.
“I like technology, but I do have a big issue with it,” Dr Nieroda said.
“Very often it is made for people who are technology users and are already familiar with how digital tools work.
“When I look at many of the apps that we see on the market, especially the ones that are really well-developed, they are designed with younger and tech-savvy users in mind.”
Dr Nieroda believes that tech companies should have the full breadth of stakeholders in mind when developing a new solution, especially taking into account people who are not tech-literate.
She argues that the healthcare sector should be doing more to cater to those who do not want to use technology or lack the skills to use it to its full potential.
“When it comes to access for those really vulnerable groups, I think we have to recognise that technology might not necessarily be something that has purpose for those people,” she said.
“They might not even see the need to use it. So, how do you translate this purpose and how do you help those people use it in a meaningful way?”
Differentiating between accessibility and inclusion
The term accessibility is generally associated with factors such as font, colours, touch and other requirements laid out in government guidelines.
Researchers at UCL conducted surveys of entrepreneurs in the healthcare sector to understand what accessibility meant to them and how they addressed it.
The results were an “eye-opener” for Dr Nieroda as the overlaps between access and inclusion became apparent.
A common thread among respondents was the risk of digital exclusion and cultural barriers in health tech.
Dr Nieroda drew attention to the issue of clinical studies predominantly conducted with “willing” participants, who tend to be overrepresented by white, educated, middle-class individuals, leading to biased recommendations.
This bias not only affects the accuracy of recommendations but also perpetuates inequities in healthcare.
By broadening the scope of accessibility research, including diverse stakeholders and conducting inclusive clinical trials, the development of purposeful and effective healthcare tools becomes possible.
“You realise that access is one of the problems that could be captured within the broader aspect of inclusion,” she said.
“How do we personalise and make things purposeful?
“Of course, there are so many different elements and I think that accessibility, in that narrower term, seems like a cherry on top because there are so many things before that that need fixing.”
“There are much deeper levels sitting at the system level.”
Turning the focus to system-level challenges
Dr Nieroda began her research career studying the different interactions people have with technology and soon developed an interest in these interactions within the unique context of healthcare.
“The whole system is very closely connected,” she said.
“There are so many different stakeholders within that system that really impact how people experience those services and the technologies.”
“We really need to understand some of those interactions within the systems rather than with the technology, because there are a lot of different things that impact how people interact with technology.
Understanding these interactions within the healthcare system itself is critical for boosting access and inclusion. But bringing about systemic change is not an easy task.
The solution is unlikely to come from organisations working in silos with their own pots of resources, Dr Nieroda argued.
Instead, interdisciplinary collaboration is needed to address the complexities of inclusion, including cultural nuances.
“I think it’s a process,” she said. “You need to start with people; what is the purpose for people in relation to their different behaviours?
“We need to understand this within the context of their culture and their environment.
“It’s not necessarily that technology developers or companies offering these solutions will be able to solve those problems.
“I don’t have the exact answer, but I think it’s [about] starting with people in their environment, in their cultures, in their behaviours, and then bringing different stakeholders together.”
The role of marketing in improving inclusion
Academia’s narrow focus often restricts the interdisciplinary collaboration that is necessary for a comprehensive understanding of consumer behaviour in healthcare.
“I will be honest, this is the challenge with academia and academic research, Dr Nieroda said. “Very often, we are trained in a certain area.
“We have to be an expert in that area, but that often doesn’t allow us to have a bigger, broader view.”
Dr Nieroda has identified limited market research approaches that would enable a better understanding of people’s behaviours across the healthcare system.
By looking only at how people interact with a specific technology or an organisation, for example, the NHS, many other important systemic factors slip through the net.
“To me, it’s about the person’s journey through the system rather than the journey with a specific solution,” she added.
Dr Nieroda believes that marketing and communications could play an important role in bridging this gap.
She is currently promoting market research, employing systems thinking to understand the consumer’s journey through the healthcare network as a whole rather than optimising specific services.
“I’ve spent a lot of time looking at research and [found] we could benefit from more comprehensive market research approaches that enable us to understand consumer behaviour across the system. I think this is really important to understand.
“Something that I’m really trying to develop at the Global Business School for Health is market research at a systems level, which will really enable us to think about person-centred systems.”