When do health and social care practitioners consider digital healthcare to be ‘good care’ for people with co-occurring alcohol-use disorder and depression? a qualitative analysis of practitioners’ accounts

Background:
People with alcohol-use disorder (AUD) and depression may experience a range of barriers to accessing formal healthcare; utilising digital technologies has been proposed as one way to improve provision for this population. The COVID-19 pandemic rapidly expanded the use of digital health in mental health and substance use services, which had previously been slow to implement telemedicine or m-health approaches. This study aimed to explore when health and social care practitioners, who work with people with AUD and depression, consider digital healthcare, in particular telemedicine and m-health to be ‘good care’. The work has implications for the development and implementation of digital healthcare for this population.

Methods:
A qualitative study was carried out using semi-structured interviews with 26 health and social care practitioners in the North-East and North Cumbria area of England, UK, who work with people with AUD and depression. Purposive and snowballing sampling approaches were adopted. Data were analysed inductively using thematic analysis and then framed using concepts from Ethics of Care Theory, principally, Tronto and Fisher’s four phases and ethical elements of ‘good care.’

Results:
Themes were grouped into the four phases/ elements of care: Attentiveness (digital exclusion / inclusion, safety); Responsibility (in addition to a wider infrastructure of in-person support); Competence (embodiment and physicality, flexible and adaptable); and Responsiveness (honesty, and motivation). The findings also highlighted the importance of considering the relational contexts of people with AUD and depression.

Conclusions:
There are some areas where practitioners perceive that digital healthcare can be valuable for people with AUD and depression. For example, it can be more flexible than current provision, it can be inclusive for some people, and it can offer a level of anonymity. However, for digital healthcare to be considered to provide good care, there should be attentiveness to people’s material and relational circumstances, and their levels of digital literacy, to ensure inequalities in this population are not exacerbated.; it should always be part of a wider package of in-person relational support. Attention should always be given to safety features and planning.