The Uneven Involvement of Older People in Digital Health Research: An Under-investigated Inequality Mechanism

Einleitung The involvement of older people in research on digital technologies is uneven. Some groups of older people, e.g. the older ones, are less likely to participate in research which evaluates new digital health technologies, compared to their counterparts. This is likely to bias research results and produce wrong research conclusions. By taking an inequality perspective, an in-depth investigation of the involvement of older people in research on digital health technologies and its impact on research conclusions will be presented. It will be discussed why the unequal involvement of older people in digital health research can be considered as an inequality mechanism which contributes to widening digital and social inequalities among older people.

Methoden The involvement of older people in research was studied within two intervention studies which evaluated two types of digital health technologies, namely a web-based system for monitoring the postoperative progress of individuals after a day surgery (i.e. Mobile Phone in Recovery after Ambulatory Surgery project – MIRAS) and an exergame intervention for improving physical activity among individuals with heart failure (i.e. HF-Wii project). Involvement in research is conceptualised as resulting from three selection processes: pre-screening, recruitment, and self-selection. Based on field information and survey data, (1) the (non-)involvement and (2) the individual decision to participate (or not) in the two evaluations, were modelled. Furthermore, in the context of the MIRAS intervention, a weighting procedure was implemented to adjust the intervention results for the over-representation and the under-representation of groups of older people in the sample.

Ergebnisse Main findings indicate that increasing age enhances the likelihood of not being screened, not recruited and to decline the invitation to participate in digital health research. Decliners and those who decided to participate differ by age, gender, job, health status, digital skills. Regarding the weighting study, weighted and unweighted intervention results differed one another. The unweighted intervention results were over-positive with regards to the efficacy of the MIRAS intervention due to the under-representation of groups of older people who were older and men.

Schlussfolgerung Results suggest that very specific groups of older people are more likely to be involved in evaluations of digital health interventions. Old-age diversity is not properly reflected in digital health research. This biases the results towards overestimating the efficacy, generate inaccurate conclusions which, in turn, can inform inappropriate digitalisation strategies and policies. The new digital-based health services can result in not being properly accessible and usable for those groups of older people who are systematically neglected in digital health research.

Publication History

Article published online:
22 August 2022