Consumer and provider preferences for digital health technologies to improve access to comprehensive primary health care in very remote Aboriginal communities in the Northern Territory of Australia

INTRODUCTION: Access to comprehensive primary health care in very remote Aboriginal communities in the Northern Territory (NT) of Australia is limited by local primary healthcare workforce shortages. Digital health technologies (DHTs) have the potential to improve access, but user co-design of the technology is a critical success factor for uptake, effectiveness, and sustainability. This study aimed to elicit the relative preferences of a very remote Aboriginal community and their primary healthcare providers (clinicians and health service managers) for DHT attributes on a common scale. METHODS: Twenty-four attributes of DHTs were identified through qualitative research with a very remote, almost exclusively Aboriginal, community to improve access to comprehensive primary health care. A D-efficient incomplete block design was used to arrange the attributes in a best-worst scaling survey for preference elicitation. The survey was administered in-person from January to June 2024 by Aboriginal community-based researchers to a target sample of 20% of the community's Aboriginal population, stratified by age and gender. Primary healthcare providers working in the NT were invited through professional networks from November 2024 to September 2025 to complete the same survey online. Results were analysed using multinomial logit models by stakeholder group: Aboriginal community members and primary healthcare providers. RESULTS: Representative samples comprising 46 Aboriginal community members (24% of the community's adult population) and 50 NT primary healthcare providers (80% clinicians and 20% health service managers) completed the survey. Results showed a substantial divergence between Aboriginal community members' and healthcare providers' preference scores for DHT attributes; 12/24 (50%) attributes differed significantly between the groups. However, both groups had high preference scores for 'a support person available to interpret so patients can understand, communicate, and participate in discussions with [the] health professional', 'respect[ing] the patient's culture and community', and 'minimis[ing] travel away from community'. The Aboriginal community members' preferences for DHTs to reduce wait times for a specialist appointment, reduce wait times on the day of any healthcare appointment, and functionality to involve a family member/carer in discussions with health professionals when needed, were considered less important by healthcare providers. Instead, primary healthcare providers preferred that DHTs be used to provide information to help patients clearly understand and manage their own and their family's health. CONCLUSION: When designing comprehensive primary healthcare models that use DHTs to optimise service delivery in remote NT Aboriginal communities, it is of utmost importance for Aboriginal community members and healthcare providers that the service delivery models provide support persons to help patients understand, communicate and participate fully in healthcare discussions, demonstrate respect for the patients' culture and community, and minimise travel away from community. Investment in DHTs for remote NT Aboriginal communities should prioritise solutions that reduce the time to obtain a specialist appointment and wait times on the day of any healthcare appointment. Given the notable differences between the preferences of Aboriginal community members and primary healthcare providers, it is important that all stakeholders are involved in design through implementation, monitoring and evaluation to ensure effective and sustainable digital health initiatives.