Theory and Practice in Digital Behaviour Change: A Matrix Framework for the Co-Production of Digital Services That Engage, Empower and Emancipate Marginalised People Living with Complex and Chronic Conditions

Abstract

Background: The WHO framework on integrated people-centred health services promotes a focus on the needs of people and their communities to empower them to have a more active role in their own health. It has advocated five strategies including: Engaging and empowering people and communities; co-ordinating services within and across sectors; and, creating an enabling environment. Any implementation of these strategies needs to occur at individual, community, and health service levels. Useful steps to reorganising health service provision are already being guided by existing models of care linked to increased adoption and use of digital technologies with examples including: Wagner’s Chronic Care Model (CCM); Valentijn’s Rainbow Model of Integrated Care (RMIC); and Phanareth’s et al.’s Epital Care Model (ECM). However, what about individuals and the communities they live in? How will strategies be implemented to address known inequities in: the social determinants of health; access to, and use of digital technologies, and individual textual, technical, and health literacies? Proposal of a matrix framework: This paper argues that people with complex and chronic conditions (PwCCC) living in communities that are at risk of being under-served or marginalised in health service provision require particular attention. It articulates a step-by-step process to identify these individuals and co-produce mechanisms to engage, empower and ultimately emancipate these individuals to become activated in living with their conditions and in their interactions with the health system and community. This step-by-step process focuses on key issues related to the design and role of digital services in mitigating the effects of the health service inequity and avoiding the creation of an e-health divide amongst users when advocating digital behaviour change initiatives. This paper presents a matrix framework providing a scaffold across three inter-related levels of the individual; the provider, and the health and care system. The matrix framework supports examination of and reflection on the design and role of digital technologies in conjunction with pre-existing motivational instruments. This matrix framework is illustrated with examples from practice. Conclusion: It is anticipated that the matrix framework will evolve and can be used to map and reflect on approaches and practices aiming to enrich and stimulate co-production activities supported by digital technology focused on enhancing people-centred health services for the marginalised.

Engaging Children and Young People in Digital Mental Health Interventions: Systematic Review of Modes of Delivery, Facilitators, and Barriers

“…The purpose of the interventions is also in line with WHO’s classification of DHIs [ 72 ]. The intervention-specific and person-specific influences on CYP engagement identified in the present review mirror those of previous research on the broader technology acceptance model [ 73 - 75 ], the conceptual framework for engagement in Digital Behavior Change Interventions in adults [ 36 , 53 ], and more recently, the application of social cognitive theory to understand engagement with DHIs for trauma recovery [ 35 ]. For these models, predictors included perceived need, engagement self-efficacy, outcome expectations, and symptom severity.…”

“…A key facilitator of professional connectedness was credibility in relation to evidence of the intervention’s effectiveness and trust in the privacy and data security, which could be facilitated by using familiar brand names . Although characterized as an intervention-specific factor in other models [ 53 ], we characterized this as part of opportunities for connectedness and, therefore, as a person-specific factor. Future studies should explore the impact of new modes of delivery to promote a sense of connectedness in DHIs (eg, more usage of features such as ChatBots, as in the Manage Your Life Online intervention).…”

“…Other barriers and facilitators that were identified in this review also emphasize the importance of user-centered design methods when developing DHIs for CYP [ 53 ]. Through co-design workshops and focus groups with CYP, developers can ensure that a DHI’s design is age appropriate, (eg, little text and using youth-engaging language) by putting a greater focus on videos and pictures, while keeping the platform user friendly.…”

“…A descriptive numerical summary was presented to group articles by the primary digital platform used to deliver the intervention. SL completed a qualitative data-driven thematic analysis [ 52 ] in addition to inductive analysis informed by the Digital Behaviour Change Framework [ 53 ] to address the second review question. Moreover, this framework and the capability, opportunity, motivation, and behavior (COM-B) model [ 54 ] were used to explore the factors influencing behavior change and intervention design.…”

Health literacy, digital literacy and eHealth literacy in Danish nursing students at entry and graduate level: a cross sectional study

“…This requires healthcare workers to be aware of both the concept of HL and how the digitalisation can either impose a barrier or be a facilitator in the provision of care. To understand the digital aspect the health care workers also need to have an understanding of the patient's digital literacy (DL) and eHealth Literacy (eHL) [5,6].…”