Lets talk about Motivation.

For an individual to use health technology, they must be motivated to do so. Before we consider how we might be able to influence people’s motivation, we need to first understand what causes low motivation. Equiti Health’s research identified motivation as a critical factor in technology use, which is influenced by several factors.

Motivation is highly influenced by psychological factors; the largest being trust. In some individuals, a lack of trust flows from a general mistrust of technology, while in others, a lack of trust stems from a lack of trust in the wider medical community[1]. For example, public trust was thought to have influenced whether an individual downloaded and used the UK’s NHS COVID-19 app[2].

For some communities, particularly ethnic minority populations, a lack of trust is a consequence of experienced racism, bias and perceived injustice. For example, during COVID-19, over 90% of black patients with diabetes in a US region had access to technology and the skills to use technology, yet telehealth use within this population was only 39%. The researchers investigated possible reasons for this, such as age, gender, education and cognitive ability, and found the predominant reason was a lack of trust[3].

Trust in data privacy is another factor influencing use. While most developed countries have created robust legislation to ensure data privacy and protect the right of an individual to keep his / her information private from others e.g. Europe’s GDPR and USA’s HIPAA, this is not the case globally. Only 61% of countries in Africa and 57% in Asia have adequate legislation in place [4] and these countries will face significant barriers to technology use in the absence of robust privacy and data protection laws. Even when robust legislation exists, privacy remains a key concern of some vulnerable populations, such as those with conditions attracting stigma and discrimination e.g., HIV, mental health, sexual health conditions and people with disabilities[5].

The motivation to use technology is influenced by whether an individual views the technology as culturally appropriate. Greater use was found when technologies were viewed as culturally reflective by users[6]. Leaning in and engaging with minority communities throughout the design and roll out of technology is therefore a vital strategy to ensure technology is used by these communities.

Confidence in using technology is psychological barrier for some, which may influence motivation and present a barrier to technology use, which is not always reflective of a person’s actual skills or an individuals’ capacity to learn. Our research identified confidence was particularly lacking amongst older adult users, and ethnic communities.

How can we start to address this?

Co-design approaches have been used to successfully address community mistrust[7] which led to more equitable technology use. Healthcare providers have a role in promoting and explaining technology to their patients. Provider endorsement, validation and recommendations were shown to contribute to patient’s willingness to engage with technologies and was successful in increasing trust[8]. Providing training and support, culturally-specific support, to help patients use technologies has been shown to increase trust, address privacy concerns and results in better uptake, yet this key aspect is often overlooked.

The motivation to use technology is a key factor that will influence technology use across a population. However better leaning into and engaging with these communities throughout a technology deployment can start to address this and ensure more equitable use.

[1] https://www2.deloitte.com/uk/en/insights/industry/health-care/trust-in-health-care-system.html [2] Dowthwaite, L., et al. (2021). Public Adoption of and Trust in the NHS COVID-19 Contact Tracing App in the United Kingdom: Quantitative Online Survey Study. Journal of Medical Internet Research, [online] 23(9), p.e29085. doi:10.2196/29085. [3] Zielinska, E. (2021). Why Telehealth is Not Meeting the Needs of African Americans with Diabetes. [online] Health Nexus. Available at: https://thehealthnexus.org/why-telehealth-is-not-meeting-the-needs-of-african-americans-with-diabetes/ [Accessed 26 Aug. 2022]. [4] UNCTAD. (2022). Data Protection and Privacy Legislation Worldwide. [online] Available at: https://unctad.org/page/data-protection-and-privacy-legislation-worldwide [Accessed 3 Sep. 2022]. [5] McDonald, N. and Forte, A. (2022). Privacy and Vulnerable Populations. SpringerLink, [online] pp.337–363. [6] Montague E;Perchonok J (2012). Health and wellness technology use by historically underserved health consumers: systematic review. Journal of medical Internet research, [online] 14(3).. [7] Kronenfeld, J.P. and Penedo, F.J. (2021). Novel Coronavirus (COVID-19): telemedicine and remote care delivery in a time of medical crisis, implementation, and challenges. Translational Behavioral Medicine, [online] 11(2), p.659 [8] Turnbull, S., Lucas, P.J., Hay, A.D. and Cabral, C. (2021). The role of economic, educational and social resources in supporting the use of digital health technologies by people with T2D: a qualitative study. BMC Public Health, [online] 21(1), pp.1–12. ‌