Digital exclusion faced by people living with chronic respiratory disease: Challenges, implications and solutions

The introduction of digital health technologies (DHTs) to support the diagnosis, assessment, and management of chronic respiratory diseases (CRD) has great potential to democratise access to healthcare, but will suffer if these new technologies cannot be fully utilised by the patients most at need, particularly those from underserved communities. This narrative review addresses the challenges and potential solutions for reducing digital exclusion for people living with CRD. Although sparse, the available evidence suggests that digital exclusion leads to poorer health outcomes in people living with CRD. The barriers that lead to digital exclusion intersect at many different levels and include socioeconomic, demographic, geographical, digital literacy, design/accessibility and psychosocial factors. Solutions to mitigate digital exclusion in people with CRD need to operate at multiple scales with cross-sectoral collaboration, and range from ensuring access to digital tools via large national mobile/broadband infrastructure developments to ensuring DHTs for patient use are designed inclusively and frontline healthcare staff are trained to help patients engage with the tools. Currently, there is a real risk that deploying digital health interventions for CRD care may widen the digital divide and deepen health inequities. To deliver on the digital health promise, all relevant stakeholders need to be focussed on ensuring that the presence of digital exclusion is well monitored and underserved communities such as CRDs are not systematically excluded from implementation and evaluation efforts.