The influence of digital self-care interventions on health inequality in high burden chronic health conditions

Student thesis: Doctoral ThesisDoctor of Philosophy (PhD)


Chronic conditions are a considerable burden for patients and health services and have been shown to have social patterning in severity and incidence. Digital interventions have the potential to reduce pressure on health services and reduce health inequities by increasing access to healthcare that can be tailored to the needs of the users. However, there is limited evidence available about the influence of these interventions on health equity. This thesis aimed to explore differences in the use and effectiveness of web-based interventions between groups with different social characteristics in a mixed methods study.

Two systematic reviews were conducted to explore the differences in i) use, and; ii) effectiveness of web-based self-care interventions for high burden chronic conditions between people with different social characteristics. Four physical health conditions were included: asthma, chronic obstructive pulmonary disease, diabetes and osteoarthritis. The reviews indicated that people with lower socioeconomic status may be less likely to use these interventions. For those who did use the interventions, men, minority ethnic groups and those with higher levels of health literacy benefitted more from them. However, there were several major limitations with the methodology and reporting in reviewed studies, which limited the strength of the evidence.

A qualitative interview study was undertaken to establish: how and why people with Type 2 Diabetes(T2D) use web-based self-care technology and how their experiences vary. The study indicated that the internal (knowledge, digital skills) and external (social, financial, status) resources available to people with T2D influenced whether they heard about, could access and use digital interventions. The technology people with T2D had access to and used was influenced by and interacted with their diabetic identity. For those who used these technologies, the interventions supported self-care and influenced the way the person with T2D was viewed by others.
Date of Award21 May 2019
Original languageEnglish
Awarding Institution
  • The University of Bristol
SupervisorPatricia Lucas (Supervisor), Christie L Cabral (Supervisor) & Alastair D Hay (Supervisor)


  • Health inequalities
  • Health inequity
  • chronic condititions
  • diabetes
  • digital
  • interventions
  • online
  • web-based

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