Digital healthcare: unknown makes unloved

Teleconsultations, patient portals, and home-monitoring devices. Governments and healthcare institutions see digital care as the solution. Assistant professor Esther Metting, an expert in digital care, also sees the potential. At the same time, she emphasizes that many people are currently being left behind digitally. In this episode of the JTS Scholars, she explains what we can do about that.

Text: Jelle Posthuma

Metting’s research focuses on the implementation of digital care. Digital health care comprises a wide range of possibilities: from simple applications such as looking up information on Thuisarts.nl or using patient portals, to more complex solutions such as telemonitoring, where patients, for example, measure their own blood pressure and send the results to their healthcare provider.

Future healthcare

According to Metting, digital care can make an important contribution to organizing healthcare more efficiently. At the same time, a large group of citizens cannot use this form of care. ‘This concerns about 20 to 25 percent of the population. It’s not just about skills. Many people are afraid to use it or simply don’t know what it is. This group does not have access to the most optimal care of the future. That problem is becoming increasingly significant.’

And that is unfortunate, because for many people, digital care is a real solution. Citizens can easily and accessibly look up reliable information, schedule appointments, send messages to doctors, or order medication. Through home measurements, people can also signal problems at an earlier stage. 'It leads to better and more personalized care', Metting notes.

This is a major advantage for those who do participate, she continues. 'As we do more digitally, the gap between groups will only grow.' Moreover, digital skills are not black and white: a person is not simply digitally skilled or not. 'Almost everyone can use WhatsApp. But using a DigiD is complicated for many, including young people. Nearly ten percent of 16- to 19-year-olds lack basic digital skills.'

Motivation

In 2021, Metting received a VENI grant for her research into the health benefits of digital care. The assistant professor studied the international context, conducting focus groups in Germany, England, Belgium, and the Netherlands. Surveys were also conducted in seven other countries. Interestingly, digital skills do not appear to be decisive. 'Other factors, such as fear and expectations, are much more important. Digital skills are not predictive of technology acceptance', she summarizes.

Metting cites the example of her research with COPD patients, a group that tends to be older and not always digitally skilled. 'But a section of this group does consider it very important and is highly motivated.' Often patients have no idea what digital care is, she continues. And this unfamiliarity is precisely the issue. 'Informing people is more important than offering training to improve their digital skills. When people understand why they are doing something, they are more likely to participate.'

This raises the question: what can be done about the motivation? Governments and healthcare organizations must clearly show what digital care options are available, Metting emphasizes. 'At a hospital in Leuven, I saw a good example of how it should be done. When patients enter, they immediately see a desk where they can ask questions about digitalization.' In the Netherlands, there are also many support services – at hospitals or libraries, for example – but these often struggle with visibility and accessibility. 'Many patients aren’t aware of them, and the same is true for medical specialists, who often don’t know they can refer patients to these services.'

A broad perspective

Metting works at both UMCG and the Faculty of Economics and Business (FEB) at the University of Groningen. 'In my research, I draw on knowledge from psychology, epidemiology, and organizational sciences. My research group also consists of very diverse researchers with varied backgrounds. With that broad, interdisciplinary perspective, we study digital healthcare.'

According to Metting, the field of digital care is inherently interdisciplinary. 'You’re dealing with technology, the organizational context, and the person who must use it. That’s why it’s so important to collaborate with researchers from different faculties. I was trained as a psychologist and epidemiologist, focusing on the impact on individual behavior. At FEB, I learned to look at these issues more broadly, from an organizational perspective. You want to understand whether a digital application works and is implementable.'

It’s precisely in the implementation of digital care innovations that things often go wrong, Metting notes. 'In my field, there is much research into apps and other applications, but often from a clinical perspective, and not from practice. It is essential to also look from an organizational perspective, so innovations can be aligned with real-world needs. I find it fascinating to combine these different perspectives. A broad outlook increases a project’s chance of success.'

Ivory tower

As a Scholar of the Jantina Tammes School of Digital Society, Technology & AI, Metting wants to focus on building a bridge with society. 'At the university, we often work from an ivory tower, focusing in great depth on one tiny area – valuable and important, but we sometimes forget to involve society. You notice there is a lot of distrust toward science, especially when it comes to digital technology. That’s why it’s important to involve people, to explain what we’re doing, and to let them try things out. That’s what I hope to do at JTS, in collaboration with the other Schools. Through JTS, for example, I recently received funding to purchase a robot so we can talk with people about robots in healthcare.'

According to Metting, scientists are not always good at explaining their research in plain language. 'Research is often very detailed or filled with technical terms. But I see it almost as a duty to be able to explain scientific research properly. For instance, with my research group, we organize information sessions in community centers, which we will expand next year. As a university, we need to work less in isolation and show what we’re doing.'