Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 22, 2024
Open Peer Review Period: Aug 23, 2024 - Oct 18, 2024
Date Accepted: Nov 26, 2024
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Examining intersectionality in multiply disadvantaged patients: A study of barriers to uptake of video consultations in older adults from disadvantaged backgrounds with limited English
ABSTRACT
Background:
The rapid shift to video consultation services during the COVID-19 pandemic has raised concerns about exacerbating existing health inequities, particularly for disadvantaged populations. Intersectionality theory provides a valuable framework for understanding how multiple dimensions of disadvantage interact to shape health experiences and outcomes.
Objective:
To explore how multiple dimensions of disadvantage - specifically older age, limited English proficiency, and low socioeconomic status - intersect to shape experiences with digital health services, focusing on video consultations.
Methods:
Guided by intersectionality theory and digital capital concepts, semi-structured narrative interviews were conducted with 17 participants aged 65 or older from diverse ethnic backgrounds in the Redbridge borough of London. Interviews explored participants' experiences accessing healthcare virtually. Intersectional narrative analysis was used to identify key themes and examine how different forms of disadvantage interact. Theoretically-informed narrative portraits and user personas were developed to synthesize findings.
Results:
Analysis revealed that digitalisation of healthcare can exacerbate existing inequities, erode trust, compound oppression, and reduce patient agency for multiply-disadvantaged patient populations. Examining intersectionality illuminated how age, language proficiency, and socioeconomic status interact to create unique barriers and experiences. Key themes included: weakened presence in digital interactions, erosion of therapeutic relationships, shift from relational to distributed continuity, increased complexity leading to disorientation, engagement shaped by prior experiences of discrimination, and reduced patient agency.
Conclusions:
This study provides critical insights into how the digitalisation of healthcare can deepen disparities for older, low-income, limited English speaking patients. By applying intersectionality theory to digital health disparities, our findings underscore the urgent need for multifaceted approaches to digital health equity that address the complex interplay of disadvantage. Recommendations include co-designing inclusive digital services, strengthening relational continuity, and developing targeted support to preserve agency and trust for marginalized groups in an increasingly digital healthcare landscape.
Citation
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Copyright
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