JMIR Publications

ABSTRACT

Background:

The NHS 10 Year Health Plan emphasises an increasing shift toward digital healthcare delivery. However, there is limited research on how best to support, engage, and include individuals who are digitally excluded. As services become more digitally driven, there is need for evidence-based interventions that effectively address digital inclusion and ensure equitable access to care.

Objective:

This study aimed to evaluate the feasibility and acceptability of providing digital literacy training alongside a digital health intervention (Ex-Tab), compared with usual care. The study used Kidney Beam (a digital health intervention designed to promote physical activity and improve quality of life in people living with chronic kidney disease (CKD)) as an exemplar digital health intervention (DHI).

Methods:

This mixed-methods, single-site pilot randomised controlled trial (RCT) recruited 40 adults with CKD who were digitally excluded, defined as lacking access to a Wi-Fi–enabled digital device or scoring <7 on the Vanderbilt University Medical Centre digital health care literacy screening tool (DHLS) were included. Participants were randomised 1:1 to the Kidney Beam Ex-Tab digital inclusion intervention or to Kidney Beam alone. Participants in the intervention group received a Wi-Fi–enabled iPad with the Kidney Beam DHI pre-installed, along with training on device use and support to access the 12-week Kidney Beam DHI (twice-weekly live exercise and education sessions). The control group received sign-up instructions for Kidney Beam only. Feasibility outcomes, measured using a priori progression criteria, included screening, recruitment, retention, adherence, safety, and acceptability. Secondary outcomes were Kidney Disease Quality of Life questionnaire, Chalder Fatigue questionnaire and Patient Health Questionnaire-4 (PHQ4). Assessments were conducted at baseline and at 12 weeks. Acceptability and user experience were explored through semi-structured interviews (n=25) at 12 weeks (both groups).

Results:

Between September 2023 and September 2024, 169 individuals were screened and 40 enrolled (median age 66.5 years; 50% male, median DHLS 4), with 21 randomized to Ex-Tab and 19 to control. Thirty-five participants (88%) completed the 12-week follow-up (Ex-Tab n=18; control n=17). All feasibility criteria for recruitment, retention, adherence, and safety were met. The interviews found that the tablet-loan and training component was valuable and acceptable, noting that it enhanced engagement and motivation with the exercises. Providing loaned devices was especially welcomed for overcoming access barriers, particularly among those who could not afford their own.

Conclusions:

Providing Wi-Fi–enabled devices and digital literacy training through the Ex-Tab intervention was feasible and acceptable for people with lower levels of digital literacy. All pre-specified feasibility criteria were met, supporting progression to a future definitive multicentre trial or implementation study. Findings offer insight into the design of digital inclusion strategies that may be transferable to other long-term health conditions. Clinical Trial: The sub-study was approved by the Bromley NHS Research Ethics Committee (Ref: 21/LO/0243) and Health Research Authority, and was pre-registered on ClinicalTrials.gov (NCT04872933).