JMIR Publications

ABSTRACT

Background:

The use of online services within primary care in the National Health Service (NHS) in England is increasing although evidence suggests slow and uneven uptake, with medically underserved populations less likely to engage with online services than other patient groups. ‘Digital facilitation’ (DF), referring to) - a range of processes, procedures, and personnel which seek to support patients in uptake and use of online services - may be one way to address these challenges. However, the models and impact of DF currently in use are unclear.

Objective:

To identify, characterize and differentiate between different approaches to DF in primary care; to establish what is known about the effectiveness and cost-effectiveness of different approaches, and to understand enablers for DF.

Methods:

Adopting scoping review methodology, we searched academic databases (PubMed, Embase, CINAHL, Web of Science, Cochrane Library) and grey literature published between 2015 and 2020. We conducted snowballing searches of reference lists of included articles and of articles identified during screening as relevant to digital facilitation, but which did not meet inclusion criteria due to article type restrictions. Titles and abstracts were independently screened by two reviewers. Data from eligible studies were analyzed using a narrative synthesis approach.

Results:

Eighty-nine publications were included. The majority (n = 71) concerned DF approaches targeted at patients (promotion of services, training patients to improve their technical skills, or other guidance and support). Further approaches we identified focused on targeting of PC staff in supporting patients (e.g. improving staff knowledge of online services; enhancing their technical or communication skills.). Our review identified few comparative evaluations of DF approaches. Qualitative evidence suggests that some DF may be effective at promoting uptake and use of online services by patients (e.g. recommendation of online services by practice staff; coaching). We found little evidence that providing patients with initial assistance in registering for or accessing online services would lead to increased long-term use. Few studies addressed the effect of DF on healthcare inequalities. Those that did suggested that providing technical training for patients could be effective, at least in part, in reducing inequalities although not entirely. No. No studies assessed the cost-effectiveness of DF. Factors affecting the success of DF include: perceptions of the usefulness of the online service, trust in the service, patients’ trust in providers, capacity of primary care staff, guidelines or regulations supporting facilitation efforts, and staff buy-in and motivation.

Conclusions:

DF has the potential to increase the uptake and use of online services by PC patients. To understand which approaches are most effective and cost-effective, for whom, and under what circumstances, requires further research including rigorous evaluations of longer-term impacts. As efforts continue to increase the use of online services in primary care in England and elsewhere, we offer an early typology to inform conceptual development and evaluations.