17 January 2022

A dissertation from Linköping University shows that non-inclusive evaluations of digital technology in healthcare can reinforce digital inequalities. Some groups from the elderly population participate in evaluations of the technology to a lesser extent, which makes the evaluations misleading.

Older woman talking to her doctor digitally
Förnyelse av recept via en digital tjänst. En avhandling från LiU visar att de äldsta i vårt samhälle inte utvärderar ny teknik, vilket kan bidra till att de slutsatser vi drar av utvärderingar om teknik inte blir korrekta.  staticnak1983

Digital technology is playing an increasing role in our society, which makes it important that everyone has access to the technology and knows how to use it. In health care, for example, patients can digitally request a prescription renewal, book care visits and read their medical records.

In today’s society, all individuals are expected to use digital services. However, not all older people have access to and are able to use digital technologies.  Arianna Poli wanted to investigate what leads to digital inequalities among older people. She asked if digital inequalities are related to how new digital technologies are evaluated in research.

“I wanted to know how well people who evaluate technology in health care reflect the elderly in general. It turned out that some groups of older people are less represented in the evaluations I have studied. This means that research on digital technology is, in some cases, actually not fair, and that research results are not always correct”, says Arianna Poli, who was newly awarded a doctorate at Linköping University, Sweden. 

The results of her dissertation show that the elderly who participate in research on digital technology in health care are younger, healthier and more digitally equipped than the elderly who do not participate in research studies.

Researchers conducting digital health technology evaluations should involve more diverse samples of older people which better reflect the targeted users. 
Arianna Poli

In the dissertation, Arianna Poli examined, among other things, a research study which evaluated a mobile system for monitoring patients after day surgery, where the patients themselves reported the progress on their mobile phone. The dissertation showed that people aged 75 or older were less often invited to participate in the research study compared to older people in younger age groups. The reasons for this included that the elderly lacked an internet connection or mobile phone and could, therefore, neither use the mobile system nor evaluate it. The results also showed that those who agreed to participate in the research study were predominantly women, had office jobs, better health and internet skills than those who did not want to take part in the evaluation of the mobile system. Thus, not everyone had the same chances to participate in research. Participation in research was found to be unequal among different groups in the older population.   Photo credit Linda Fredrikson

Using statistical simulations, Arianna Poli found that the results of research studies on digital technologies can change significantly depending on the group of older people that participates. When too few older people with poorer health, in very old age and with lower digital skills, participate in intervention studies, the study results are likely to be biased and over-positive. This happens because the study results are based on the healthier, the younger and the digitally savvier ones who have a higher chance of achieving better outcomes compared to the other groups of older people. Arianna Poli showed that these over-positive results give an incorrect impression of the digital technologies’ usefulness for addressing older people’s healthcare needs. She demonstrated that positive effects may even disappear if one simulates that more older people with poorer health, in very old age, with lower digital skills participated in these studies. The dissertation shows how these statistical simulations can be an important tool for helping interpret and correct the unequal opportunities for some older people  to participate in evaluations of digital technology.

Based on the results of the dissertation, Arianna Poli gives recommendations on how to work to reduce digital inequality by optimising how digital technologies are evaluated.

“Researchers conducting digital health technology evaluations should involve more diverse samples of older people which better reflect the targeted users. They should always check which groups of older people are under-represented in a research study, and, either try to improve the sample by focused recruiting strategies or employing statistical procedures like weighting for correcting biased results.”  

The study: 
A Divided Old Age through Research on Digital Technologies, Arianna Poli, Linköping University. Division Ageing and Social Change, Department of Culture and Society, Faculty of Arts and Sciences, Linköping Studies in Arts and Sciences No. 814


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