Digital exclusion as a barrier to accessing healthcare: a summary composite indicator and online tool to explore and quantify local differences in levels of exclusion

Abstract Existing disparities in digital access were exacerbated with the accelerated shift to online provision of services during the COVID-19 pandemic, particularly for already disadvantaged groups. Metrics to quantify relative local differences in levels of digital exclusion are a necessary pre-requisite for the targeting of interventions to address these disparities. In this study we developed a composite indicator and an interactive dashboard ‘The Lincolnshire Digital Health Toolkit’ to explore digital exclusion in Lincolnshire, UK. To develop the indicator, individual variables were normalised and aggregated, intra-variable correlations explored, and factor analysis used to determine variable weightings. Three underlying factors were identified that explained a significant proportion of the variance in the original variables, the first two predominantly related to socioeconomic deprivation and lack of activity. In general, coastal areas in the east of the county had higher levels of digital exclusion, with significant local variation particularly within urban areas. Long travel times to reach medical facilities are an additional barrier in some communities. The toolkit has been used to support the evidence-based geographic targeting of interventions to address barriers to accessing digitally based health information and services. The impact of digital exclusion must be addressed to reduce marginalisation and isolation. The Lincolnshire Digital Health Toolkit provides a novel composite metric tailored to the conditions of this largely rural county and an interactive dashboard to support decisions on resource allocation.