Can Equity-Centered Design Narrow the Digital Health Divide? | Deloitte US has been saved
By Heather Nelson, senior manager, and Julius Tapper, manager, Deloitte Consulting LLP
We regularly hear from health systems, health plans, and life sciences companies that have implemented new technology in hopes of improving the experience for existing customers or extending their reach to attract new ones. More than 90% of health system technology executives and 57% of technology leaders from health plans say they are investing in digital to improve the consumer, customer, or patient experience, according to surveys and interviews conducted by the Deloitte Center for Health Solutions.
However, some of these stakeholders never achieve the level of engagement they expect. In many cases, a failure to address diverse cultural needs and cultivate trust within the communities they serve causes engagement to lag. For example, an app designed to connect patients to clinicians might inadvertently exclude people who don’t have a smart phone, a reliable internet connection, or who are not digitally literate.
Chief digital officers, health equity leaders, and other members of the C-suite often view technology as something that can help them meet consumers where they are and engage with them on a deeper level. Sometimes technology is viewed as a tool that can help make health more equitable. However, technology may fail to meet these goals—and could even exacerbate inequities—if not carefully designed to meet the unique needs of diverse communities. This could be particularly important when trying to connect with Black Americans who have historically been mistreated by the medical system.
We refer to this process of community engagement as equity-centered design. It is a strategy that requires careful and mutually beneficial engagement with trusted organizations that are already embedded in the community. This can provide stakeholders with a deeper understanding of consumer needs and their unique pain points.
Partnerships could build trust, strengthen ties to the community
Meet Teresa Vargas, a senior consultant at Deloitte: During the first few years of the health insurance exchanges, I worked as a ‘navigator’ to help people enroll in health insurance. I worked at a bicultural non-profit and a Federally Qualified Health Center in Chicago. These organizations were liaisons between the community and the exchange. Many people in the community were enrolling in health insurance for the first time. They didn’t understand how insurance worked, and they honestly didn’t see much value in it. While they understood that they could be fined for not having health coverage, paying $200 a month for something that wasn’t viewed as a necessity, and they might never use, didn’t make sense.
Partnering with a trusted community organization meant everything. These organizations understood health care and health insurance, and they knew the people in their community. We would sometimes sit down with people at health fairs and churches and enroll them on the spot. Sometimes that person would put us in touch with a relative or a friend who also needed insurance. There isn’t a communication system that’s more effective than word of mouth.
During this time, we used laptops and hotspots to navigate, educate, and enroll people in health plans. However, as technologies have evolved, leveraging smartphone apps and telehealth platforms could help expand access to care providers; face-to-face assistance could lead to more inclusivity and effectiveness. Thinking of new technologies that would allow families to stay home and not take time off from work or pull them away from their obligations could help reduce stress and help people access the care they need, when they need it.
Equity-centered design could drive culturally nuanced interactions
Trust is essential for creating effective digital engagement. However, the health care industry has historically struggled to achieve a consistently high level of trust, especially among racially and ethnically diverse populations. In a 2021 blog, we explained that mistrust in health care runs deep and is personal. Here are a few strategies that could help stakeholders build trust and improve consumer engagement:
Partner with community organizations: Building relationships with trusted local organizations can provide insight into the lived experience of the population. Stakeholders should be open to constructive feedback that could help make digital engagement more effective. This engagement should be mutually beneficial. Community organizations should be able to trust the stakeholder’s intentions and understand how engagement could benefit their work. A relationship with a community organization could lead to new and diverse consumer perspectives.
Incorporate diverse consumer perspectives into the design process: Surveying people in different communities—with different identities, needs, and behaviors—could help identify digital pain points that might otherwise be overlooked. Consider this: An algorithm might be useful in predicting the number of patients who will be late for appointments each day. Using equity-centered design, that algorithm could factor in some of the challenges that could cause some patients to miss or be late for appointments. For example, people from a low-resourced community might not have reliable transportation, might not be able to get away from work on time, or might need last-minute childcare. If the algorithm isn’t equity-centered, it could automate systemic bias into the system and lead to even longer wait times for patients.
Choose channels that reach diverse populations: Not everyone responds to the same type of outreach. Along with tapping a wide range of communication channels, messaging tactics should incorporate culturally sensitive language. Leverage strong relationships with community organizations to involve consumers in the design and testing of messages, as well as the selection of communication channels. Cultural competency is important to consumers and can be the foundation for improving the consumer experience. Consider this: Many immigrant populations in the US rely on messaging apps to keep in touch with friends and family in other countries. A health system that serves a high proportion of immigrants might consult with leaders in the community to determine how those apps might be an effective channel for engaging with residents.
Prioritize cultural humility: Employees and vendors involved in building a digital experience should be diverse and should understand the diverse needs of consumers. According to Deloitte research, 67% of people who identify as Black, Asian, or Hispanic trust community-based organizations as partners for their health care. Survey respondents, particularly Black respondents, said it was important to receive care from clinicians who look like them, talk like them, and/or have shared life experiences.
Conclusion
As health care and life sciences organizations become more digital, they could be leaving out an important design element if they don’t fully understand the communities they serve. To build a digital experience that sustains trust and enhances consumer experience, consider centering diverse community voices throughout the digital design and deployment process. By understanding the drivers of health, organizations can provide the right technology, infrastructure, and culturally relevant front-door experience to their members and customers.
Acknowledgements: Agha Nkama, Andrea Schiff, Phil Ayoub, Teresa Vargas, Tom Aiello
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