Designing inclusive and trusted 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.