Home Link Logo
Login

Designing inclusive and trusted digital health services

Analysis reviewing evidence and practice cases on how community co-design can improve the inclusivity and trustworthiness of digital health services.

Key messages

  • many digital health services fail to meet needs when communities are not meaningfully involved in design
  • lack of trust and relevance contributes to low uptake among underserved groups
  • community co-design improves usefulness, accessibility and legitimacy of digital services
  • ‘margins-first’ approaches prioritise people most likely to be excluded
  • measuring success should go beyond uptake to include confidence, access and trust.

Policy implications

  • digital health programmes should embed community co-design from the outset
  • power-sharing with communities is central to building trust
  • evaluation frameworks should include equity-relevant outcomes, not just usage metrics
  • commissioners and designers should resource sustained engagement rather than one-off consultation.

Gaps

  • limited empirical evaluation of long-term impacts of co-designed digital services
  • challenges in scaling community-led approaches within national programmes
  • need for clearer guidance on measuring trust and confidence outcomes.

Commentary
This analysis argues that the use of technology in care often falls short when digital services are designed without the active involvement of the communities they aim to serve. It highlights how exclusion can be embedded through design choices that assume access, confidence and trust.

In terms of care equity, the emphasis on ‘margins-first’ co-design is significant. By centring people most at risk of exclusion, digital services are more likely to address structural barriers rather than reproduce them.

The report reframes success in digital health away from simple uptake metrics. Confidence, trust and perceived usefulness are presented as equally important indicators of whether technology supports equitable access to care.

Overall, the analysis reinforces that inclusive digital health requires cultural and organisational change, not just better technology. Without genuine community involvement and power-sharing, digital transformation risks widening inequalities rather than reducing them.

Digitalisation of social care and older unpaid carers

A qualitative study examining how the digitalisation of social care affects older unpaid carers, focusing on choice, coercion and exclusion.

Key messages

  • older unpaid carers recognise potential benefits of digital social care tools
  • digitalisation is often experienced as coercive rather than optional
  • access limited by affordability barriers, including device and data costs
  • gaps in digital skills and confidence increase risk of exclusion
  • carers call for co-production and the retention of offline options.

Policy implications

  • digital social care must preserve genuine choice between digital and non-digital routes
  • funding for devices and connectivity is needed to prevent exclusion
  • carers should be involved in the design and implementation of digital services
  • margins-first approaches can help ensure digital policy reduces rather than widens inequity.

Gaps

  • evidence is primarily qualitative
  • limited evaluation of interventions addressing affordability and access
  • lack of outcome data on equity impacts for carers
  • need for research on scalable, inclusive digital social care models.

Commentary
This study shows how the digitalisation of social care reshapes everyday caring work for older unpaid carers. While digital tools were sometimes seen as useful, many carers described a loss of choice as non-digital routes were reduced or removed.

Affordability and skills gaps emerged as central barriers. For carers already managing significant responsibilities, the need to pay for devices or data and to develop digital confidence added pressure rather than relief. These constraints meant that digital systems often worked better for those with existing resources, leaving others struggling to engage.

The findings also highlight the importance of how digital change is implemented. Where carers were not involved in design decisions, digital services were more likely to feel imposed and poorly aligned with real-world caring contexts. In contrast, co-produced approaches were seen as more responsive and respectful of carers’ needs.

Overall, the study illustrates that digital social care can either support or undermine access depending on the choices made around funding, design and delivery. Retaining offline options and providing practical support for connectivity and skills are not transitional measures, but essential conditions for fair and workable digital care.

Digital technology in mental health care

A review examining the impact of digital technologies in UK secondary mental health care, with a focus on innovation, data use and co-produced digital tools.

Key messages

  • digital technologies are increasingly used in secondary mental health care settings
  • co-production with people who experience chronic mental health conditions is essential to effective digital design
  • digital tools offer opportunities to improve understanding, monitoring and sharing of mental health data
  • innovation is occurring unevenly across services
  • evidence on effectiveness and long-term impact remains limited.

Policy implications

  • digital mental health tools should be co-produced with service users
  • secondary care services need support to evaluate digital interventions robustly
  • data governance and information-sharing arrangements are central to safe digital innovation
  • implementation should proceed cautiously alongside ongoing evaluation.

Gaps

  • lack of long-term outcome studies in secondary mental health care
  • small sample sizes limit generalisability
  • limited consideration of multiple protected characteristics
  • insufficient evidence on equity impacts of digital mental health tools.

Commentary
This paper highlights both the promise and the uncertainty surrounding digital technologies in mental health care. While new tools offer opportunities to enhance data sharing and clinical insight, their success depends heavily on alignment with service users’ needs and experiences.

A recurring theme is the importance of co-production. Digital tools designed without meaningful involvement of people living with mental health conditions risk being poorly adopted or misaligned with real-world care. This is particularly relevant in secondary care, where needs are often complex and long term.

At the same time, the review points to a thin evidence base. Small studies and short follow-up periods make it difficult to judge whether digital interventions improve outcomes or simply add complexity to already stretched services.

Overall, the paper suggests that digital innovation in secondary mental health care should prioritise learning and evaluation over rapid scale-up. Careful design, inclusive involvement and longer-term evidence are needed if technology is to strengthen care without introducing new forms of exclusion or risk.

Everyday use and personalisation of assistive technology in dementia

A study examining how people with dementia and their family carers use, adapt and abandon assistive technology and technology-enabled care in everyday life.

Key messages

  • people with dementia and carers actively adapt and repurpose assistive technologies to fit daily routines
  • technologies are often abandoned when they do not align with lived experience or changing needs
  • unintended consequences of assistive technology use are common
  • successful use depends on contextual tailoring at home and routine level
  • many assistive technology products lack flexibility to accommodate progression of dementia.

Policy implications

  • assistive technology provision should prioritise personalisation and adaptability
  • ongoing, longitudinal support is needed rather than one-off installation
  • service models should recognise carers’ role in adapting and maintaining technology
  • procurement should consider how technologies evolve alongside changing needs.

Gaps

  • limited longitudinal evidence on sustained assistive technology use
  • lack of flexible product design that supports progression of dementia
  • insufficient integration of ethnographic insights into commissioning and practice.

Commentary
This study provides rich insight into how assistive technology is used in real-world dementia care. Rather than being passively adopted, technologies are actively adapted, modified or abandoned depending on how well they fit with everyday routines and relationships.

From a care equity viewpoint, the findings challenge assumptions that technology alone can provide support. Without tailoring, ongoing support and responsiveness to changing needs, assistive technologies may fail to deliver intended benefits and can even create new burdens.

The concept of ‘bricolage’ highlights the work done by carers to make technologies usable. This ‘invisible work’ is rarely recognised in service design or commissioning, yet it is central to whether technology supports or disrupts care.

Overall, the study stresses that the use of technology in care must be grounded in lived experience. Personalisation, flexibility and longitudinal support are essential if assistive technology is to support people with dementia and their carers equitably and sustainably.

Technology and social care in a digital world

A review examining the opportunities and risks associated with the growing use of mainstream digital technologies and technology-enabled care services in UK adult social care, particularly in the context of the planned shift from analogue to digital telecommunications networks.

Key messages

  • technology enabled care services have been used in UK adult social care for decades, but digital technologies and mainstream consumer devices are increasingly being considered for service delivery
  • the planned UK switchover from analogue to digital telecommunications networks requires large-scale replacement or upgrading of existing telecare systems
  • uneven broadband infrastructure and mobile connectivity create a digital divide, limiting the reliability of digital care technologies in some regions
  • mainstream technologies such as smart speakers are being trialled in adult social care but are not designed or regulated as safety-critical alarm systems
  • privacy, data security and informed consent issues arise when consumer technologies collect and process personal data
  • the evidence base on outcomes from technology use in adult social care remains limited, and commissioning decisions are not always informed by research evidence.

Policy implications

  • the digital switchover requires coordinated national and local planning to ensure continuity of telecare services
  • regulatory frameworks and safety standards may need updating to address the use of mainstream consumer technologies in care contexts
  • digital infrastructure and connectivity must be considered when designing technology-enabled services
  • commissioning should prioritise user outcomes and needs rather than starting with available technologies
  • stronger research evidence is required to inform large-scale adoption of new technologies in adult social care.

Gaps highlighted

  • limited empirical evidence on outcomes from mainstream technologies used in adult social care
  • the paper flags an insufficient understanding of how technology interacts with social context, user routines and care relationships
  • this review also comments on the limited evidence on how digital infrastructure inequalities affect access to technology-enabled care.

Commentary

This review examines how technology is positioned as a potential response to long-standing challenges in adult social care, including population ageing, workforce pressures and increasing demand for care. It highlights the growing interest among commissioners in using digital and mainstream consumer technologies as part of technology-enabled care services.

However, the paper emphasises that this shift is occurring alongside a major infrastructure change: the transition from analogue telephone systems to digital networks. Many existing telecare devices rely on analogue connections, meaning they must be replaced or adapted to function in digital environments. This transition introduces practical and safety challenges, particularly if systems are not upgraded in time or if connectivity is unreliable.

The review also highlights regulatory and ethical considerations associated with the use of mainstream technologies. Devices such as smart speakers are not designed as social alarm systems and therefore do not follow the same safety standards or fail-safe protocols. At the same time, concerns around data privacy, security and informed consent arise when such devices collect and process personal information.

In relation to care equity, the paper identifies the digital divide as a major concern for technology-enabled care. Differences in broadband availability, mobile connectivity, income and digital literacy mean that some communities may not be able to benefit from digital care technologies. If technology becomes a central mechanism for delivering services, these disparities could reinforce existing inequities in access to support.

Overall, the paper argues that the adoption of technology in adult social care should be guided by robust evidence and user-centred commissioning. Rather than assuming that digital innovation will automatically improve care, policymakers and commissioners must consider infrastructure, regulation, safety and user experience when designing technology-enabled services.

Shaping the future of digital technology in health and social care

An evidence review examining digital technology developments in health and social care, the barriers to adoption, and actions needed to support effective and inclusive use.

Key messages

  • The potential of digital technology to transform the health and social care system has still not been realised, though the Covid-19 pandemic has caused a rapid shift towards the remote delivery of care through online technologies.
  • digital technology adoption in health and social care is shaped by funding, infrastructure and organisational culture
  • digital exclusion remains a significant risk where support and alternative access routes are limited
  • user-centred design is essential to ensure technology meets real needs
  • data sharing challenges constrain the effective use of digital tools
  • leadership and strategic direction strongly influence digital progress.

Policy implications

  • investment in digital infrastructure and workforce skills is required to support adoption including changes in how new tools are evaluated and supported during implementation
  • user-centred and inclusive design should be embedded across digital programmes
  • clearer leadership and system-wide direction can reduce fragmentation
  • addressing digital exclusion should be a core consideration in digital strategy.

Gaps

  • evidence largely reflects the pre-Covid context
  • limited empirical evaluation of outcomes linked to specific technologies
  • uncertainty about how recommendations have been implemented across systems.
  • More evidence is needed on a range of factors, including the cost-effectiveness of such tools, the groups best suited to using these interventions, the effects of digital inequalities on access, and the impact of tools that use digital technologies on outcomes.

Commentary
This review provides a system-level view of why digital transformation in health and social care often falls short of its potential. Rather than focusing solely on technology, it highlights the importance of leadership, culture and investment in shaping how digital tools are adopted.

Barriers such as inconsistent strategic direction, digital skills gaps and weak data infrastructure are shown to limit progress. These constraints mean that even well-designed technologies may fail to deliver benefits in practice.

The review also draws attention to the consequences of neglecting inclusion. Without adequate support, digital change can exacerbate existing disparities, particularly for people with limited access, skills or confidence.

Overall, the report reinforces that effective use of technology in care depends on system readiness as much as innovation. Aligning leadership, funding and user-centred design is critical if digital technologies are to improve care without widening inequities.