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Veni project: Reducing health inequalities by opening up E-Health access for digitally non-skilled people.

A Veni Grant is a funding instrument from there NWO talent program. This grant offers your research is the opportunity to you develop their research idea over a period of three years. Esther Metting received this Grant so that she can perform research in the field of eHealtj accessibility of patients with chronic obstructive pulmonary disease (COPD).


Policy makers including the European Commission consider E-Health (use of technology in healthcare) an important healthcare priority (1) and healthcare providers are increasingly using E-Health in the diagnosis and treatment of patients. This leads to better health outcomes, particularly because care can be tailored to individuals. Unfortunately, Digitally Illiterate People (DIPs) are missing out (2) and have therefore reduced access to optimal healthcare. EHealth can improve health especially in chronic patients (3,4) because symptoms vary over the day and medical assessments are always a snapshot of reality. This complicates clinical decision-making and stresses the relevance and opportunities of E-Health. There are different type of E-Health including tele-monitoring, self-management apps, online disease information or video-conversations. COVID-19 increased the gap between digital literate people and DIPs due to an acceleration of E-Health use (5–9). Access to healthcare is a human right (10) and it is therefore urgently needed to find solutions for DIPs. Digital illiteracy is not the same as health illiteracy: people with good health literacy can still have poor digital literacy (11). The proportion of DIPs is high in older populations (>65 years), in lower educated people and in ethnic minorities even in countries where most household are connected to Internet (table 1). Chronic diseases are also
common in older and lower educated people (12), hence this group can benefit most from E-Health but are in general less capable to use it due to the high proportion of DIPs.

Tailored and theory based decision support methods can help professionals to engage DIPs but are currently not existing (14,15) because DIPs are often not included in intervention studies. There therefore insufficient knowledge about DIPs’ barriers and facilitators (15). Moreover, most E-Health studies were performed in the USA and results are not necessarily generalizable to Europe (14).  I have performed qualitative and quantitative (pilot) studies regarding E-Health access for DIPs (16–18). These studies showed that some DIPs were able to use E-Health because they found solutions to overcome their poor
digital skills, for example by engaging digital skilled family members. DIPs mentioned various barriers and facilitators of E-Health that can be divided into: contextual factors (e.g. social support), communicative experience (e.g. ability communicate with healthcare provider), individual factors (e.g. disease), system factors (e.g. app) or interaction between user and technology (e.g. poor vision) (19,20). It is essential to get in contact with DIPs to find tailored solutions to engage them in E-Health and reduce the increasing gap between digital literate people and DIPs.

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Theoretical background

Theoretical concepts can be used in decision support methods and interventions (15). The most leading theories are the “Lily model” (21)), “E-Health Literacy Model” (ELM, figure 1 (21)) and “E-Health Literacy Framework” (ELF, figure 2 (19). The Lily model provides an overview of different types of literacy (see flower in figure 1). ELF consists of 7 E-Health literacy domains divided in 3 dimensions (figure 2). In the E-Health Literacy Model (ELM, figure 1 (21)) contextual and communicative experience are added to the Lily model. The E-Health Literacy Questionnaire (eHLQ) measures the 7 domains from the ELF (19).
In my study I will combine the 7 domains of the ELF (eHLQ) with the contextual and communicational concepts from the ELM to develop a decision support method for healthcare professionals to engage DIPs in E-Health.

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Aim of my study

My innovative approach in this Veni project is that I will discover how interactions between factors derived from single factor models (figure 1,2) are related to E-Health. In cocreation with DIPs and healthcare professionals I will develop strategies for different clusters of DIPs, which is unique because DIPs are mostly not included in studies. This is challenging, however my network and experience make this approach feasible. The final aim is to develop a decision support method for healthcare professionals that will enable DIPs to benefit from E-Health References (klein en helemaal onderaan pagina?)

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