Will we see an epidemic of 'digital citizenship' in 2015? | Roz Davies

Roz Davies

My hope for 2015 is that we take a big step towards unleashing the full potential of citizens and communities to take control of their health – making full use of digital health innovations to achieve the ambition. I hope we reach the tipping point of the ‘digital citizenship’ healthcare epidemic.

Malcolm Gladwell’s seminal book, The tipping point, describes three key principles of epidemics: contagiousness, little causes that have big effects, and change happening not gradually, but at one dramatic moment – he calls that moment the 'tipping point’.

‘Sasha’ needs that tipping point...

Sasha is a powerful 65-year-old woman who lives her life well. She has a severe visual impairment caused by an autoimmune disease, chronic obstructive pulmonary disease and type 2 diabetes. She is in control of her health and at the centre of the care and support she receives from her ‘community’ and more formal NHS services. 

Sasha is able to book appointments, ask for repeat prescriptions and check her records from home, using her specially adapted technology. She lives in a rural area and does not drive, due to her visual impairment. When she needs to speak to a healthcare professional, whether her GP, the practice nurse or a hospital consultant, she is able to choose between face-to-face meetings, Skype calls, and telephone calls – and sometimes, all that’s needed is a brief email exchange. 

When Sasha was diagnosed with type 2 diabetes five years ago, she worked with her GP to explore what this meant for her, taking into account all the factors related to her lifestyle and her other conditions. The GP also recognised that Sasha was motivated and resourceful, and with all that in mind, they looked at the resources available that might help her manage her diabetes within her context, and co-created a care coordination plan. This was all recorded electronically so she could access it and amend it at any time.

Sasha was very keen to become as informed as possible; she wanted to understand how other people managed their condition, and she felt motivated to review her diet and get more active. The GP prescribed her medication and an accessible blood sugar level meter, and used social prescribing to refer her to an online self-care toolkit which linked up with her electronic health records. The toolkit also provided a discount for the local swimming pool. 

The practice nurse introduced her to a local diabetes community health champion who connected her with a friendly walking group. She attended a structured education course and felt valued when the course tutor called her beforehand to check how they could make sure it was accessible for her, taking into account her visual impairment. 

Sasha’s tale is based on a real person, but this was not her experience of being supported to self-manage her multiple conditions. All of these tools and approaches are available, but at the moment, our response to supporting people with complex multiple long-term conditions is often system-centric and fragmented. 

Sasha has spent five years with very little access to information. She has to catch two buses to get to an appointment and has never been offered an alternative. Her blood sugar level has been out of the recommended range for most of that time, which might account for the numerous infections and two emergency hospital admissions she has suffered in that period. 

She has only been prescribed medication, the first option caused debilitating IBS-like symptoms and it took two years of intrusive investigations before someone noticed that the symptoms were the same as the possible side effects of the medication. 

She attended a structured education course which was not accessible for people with visual impairments. She feels disempowered because she cannot access the information she needs, and despite being very adept at using technology, has not been given any pointers of where to go to find out more online. 

The good news is that over the last five years, we have made great leaps in our understanding of the power, potential and value of digital health and citizenship to support people to take control and live well. 

We have developed a contagious range of evidence-based citizenship approaches, for example, health champions, health trainers, social prescribing and time banking, which, when blended with digital tools such as community platforms, social media, and wearables and sensors, have the potential to improve lives and services. Giving a person easy access to information, peer support and care planning tools, giving a choice of a phone call or a face-to-face visit can all seem like small changes, but can make a big difference to individuals and subsequently to services.  

The question is, will we see digital citizenship spread like an epidemic, reaching a tipping point in our healthcare system in 2015? For Sasha’s sake and for the other 15 million of us currently living with long-term conditions, I hope so. #burningambition2015

Roz Davies is chief executive of We Love Life and an active citizen board member of Move More Sheffield. Follow We Love Life on Twitter @wellwelovelife

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