Beliefs and trust barriers to engaging with digital health services: a literature review

Summary

With more and more health services moving online, there are concerns that people who face digital barriers will also find it more difficult to access care. With funding through the VCSE Health and Wellbeing Alliance, we conducted a project to understand and co-design a resource to address belief and trust barriers to digital health services. The first stage of this project was a rapid review of evidence, conducted in May and June 2024. 

A synthesis of 26 academic and ‘grey’ literature papers published in the past five years surfaced a range of beliefs and concerns around using digital health services. The evidence also shows overlap between the groups of people more likely to lack trust in using digital health services and groups who experience more health and healthcare inequalities. The key insights from the literature review are summarised below.

For the full literature review and list of references, please download our PDF report from the downloads section.

Beliefs about digital health services

Concerns about communication challenges, leading to poorer care

• Belief that it is harder to build connections and/or communicate fully about health concerns via digital tools such as appointment booking platforms, or video consultations, leading to inappropriate or delayed care.

Concerns about getting it wrong, leading to not getting the right care

• Belief that it is easier to make a mistake using digital tools when inputting or sharing information, which could lead to not getting the right care at the right time.

Concerns about an increased burden of care for some

• Belief that increased use of digital health services, such as virtual wards, will place more responsibility onto patients and/or carers, with potential for poorer quality care.

Trust concerns around digital health services

Lack of trust in how personal data will be stored and protected digitally

• Lack of trust and understanding about how data is shared through digital health services, who has access to data and the risk of data breaches.

Lack of trust in the accuracy of data being collected and used digitally 

• Concerns that data collected through digital health services may not accurately reflect people’s lived experiences and/or may not reflect diversity of identities, leading to inappropriate decisions about care.

Lack of trust in how digital services are being rolled out 

• Perception that increasing digital health services is a cost-cutting exercise, leading to poorer access to care.

Groups most likely to experience trust concerns

• People with disabilities have lower levels of trust in the NHS
• People from lower social grades have lower levels of trust in how data is protected
• People from minority ethnic groups have lower levels of trust in how data is protected, and have more concerns about their data being used to discriminate against them
• People who experience vulnerabilities have lower levels of trust around accessing care and data sharing, eg people experiencing homelessness; refugees / asylum seekers; Gypsy, Roma & Traveller communities; sex workers
• Unpaid carers may face or perceive additional burdens around accessing care through digital.