23 Racialised exclusions in digital healthcare: combining insights from narrative interviews and human computer interaction

• Published in: BMJ open Vol. 14; no. Suppl 1; p. A9
• Main Authors: Islam, Farjana, Bailey, Sara, Rizvi, Mehdi, Netto, Gina, Kukulska-Hulme, Agnes
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 03-03-2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Digital literacy; Ethnicity; Health care access; Health services; Human-computer interaction; Racial discrimination; United Kingdom > UK
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2024-UCL-QHRN2024.23

Racialised exclusions pertaining to accessing and using healthcare services are systemic, consistent and prevalent within the contemporary landscape of health inequalities in UK cities (Wadhawan et al., 2023). Further, there is a concern that the rapid digital transformation of health services may exacerbate racialised exclusions for minoritised ethnic (ME) communities as a result of the digital divide, language barriers and digital literacy-related difficulties embedded in ethno-cultural differences (Topol, 2019). At present, there is limited understanding of the extent to which ME communities encounter systemic exclusions from digital healthcare services that require English language skills, literacy skills, accessibility to a device (e.g. a computer or smartphone) and mobile data and the skills and confidence to navigate digital platforms. Driven by a critical realist intersectional approach, our multidisciplinary research investigates the socio-technical challenges in accessing digitalised healthcare by exploring ME communities’ lived experiences. By deploying a two-tier qualitative methodology combining 100 in-depth narrative interviews with follow-up audio-visual interviews which draw on human computer interaction (HCI) methodologies, we explore how digitalised health services intersect with ethnicity and other ethnocultural dimensions to contribute to digital exclusion from healthcare services. The in-depth narrative interviews indicated how participants’ ethnicity interacted with multiple dimensions of identity as well as language, (digital) literacy, levels of informal support and income to influence access and use of digitalised primary care services. The follow-up HCI-influenced audio-visual interviews, meanwhile, enabled us to produce a more nuanced understanding of the barriers ME communities face in accessing digital healthcare, in particular, by enabling us to better explore the intersection of language barriers, digital literacy barriers and interface design. We also reflect on the challenges associated with conducting interdisciplinary research to explore the socio-technical barriers faced by different intersections of ME communities, which are often under-researched due to the linguistic or cultural diversity of ME communities.