by Caroline Brundle
We have received a far better response to a survey than we expected. Now there’s a sentence that no researcher ever really expects to write!
In March 2024 the INCLUDE study sent a survey to nearly 6,000 older people in North and West Yorkshire, asking about their use and experiences of the internet. Half of those recipients returned completed surveys, far exceeding the response rate we expected.
First, some background to the INCLUDE study (Development of methods to identify digitally excluded older people, and tailoring of interventions to meet their digital needs). Digital exclusion can affect many areas of life that influence health and wellbeing (e.g. making appointments, banking, contacting family). Older people, for whom the inability to engage in these activities can have the most negative impact (e.g. loneliness, poor housing, poor health), are the group that are most often digitally excluded. Support and training is available to increase digital inclusion, but it is usually offered when people come into contact with services, rather than systematically. Thus, some older people who might benefit from this support are not offered it, and we don’t know what support is best for them.
INCLUDE aims to i) develop a robust, replicable method for identifying digitally excluded older adults, and ii) refine and test an intervention(s) to meet their needs. The survey discussed in this blog provides the data for the first aim.
We created a bespoke survey that included questions about internet use and potential predictors of digital exclusion derived from the literature. Survey mailouts were generated by two GP practices using patient registers and posted (using DocMail) to registered patients aged 65+. Participants returned their completed surveys to the research team.
I believe the enormous response to this survey is down to a few different factors, some I think our research team can take credit for, but not all.
We worked really hard before the surveys were posted to encourage potential participants to engage with it if it landed on their doormats. We consulted older people on the content, design, wording and layout of the survey during the design process. This was done via visits to voluntary and community groups and through discussions with our PPIE members.
In addition to displaying posters in the GP practices’ waiting rooms to inform older patients they would receive the survey, we also displayed posters in pharmacies, supermarkets, libraries, places of worship, community centres, care homes, supported living schemes and other venues in the practices’ catchment areas. Urdu and Bengali versions of the poster were created, including some suitable for display in mosques.
The team, including colleagues fluent in Punjabi and Urdu, also visited various groups and venues to talk to older people about the study and encourage them to complete the survey if they were sent it. These visits and conversations also meant that staff and volunteers in trusted organisations were aware of the survey and able to encourage, support and reassure older people who might be hesitant to engage with the research.
Outside of our control, but certainly working in our favour, is the move to so many parts of life becoming digital. This meant our survey topic really resonated. “Everything is going online” is a real concern to many older people, even those who have embraced digital. There is currently a real strength of feeling about access to GP and other health services, linked to difficulties navigating online booking systems. Many people used the survey as an opportunity to voice their concerns about this in the final open comments question.
Even though we had far exceeded the sample size needed, we supplemented the postal survey to make the survey more representative of the sampled population. Follow-up calls – to the most frail non-responders living in disadvantaged areas – to offer telephone survey completion, and visits to community venues for researcher supported completion (mostly in languages other than English) added over 300 completed surveys to the total.
We’re proud that our survey response played a part in Bradford’s recent achievement of recruiting the highest number of volunteers to NIHR portfolio studies in the UK over the past year (https://arc-yh.nihr.ac.uk/bradford-leap-frogs-london-oxford-and-cambridge-to-top-uk-medical-research-table-for-first-time/).
Entering all the data into a study-specific database has been a mammoth task for our small team, so analysis has only recently begun. Early findings identify age, ethnicity, living status, socioeconomic deprivation and frailty as predictors of digital exclusion. A predictive model is being developed. This will be implementable in primary care electronic health records, allowing the identification of digitally excluded older adults to enable targeting of support to this under-served population.
For more information contact Caroline Brundle caroline.brundle@bthft.nhs.uk
INCLUDE is funded by the Dunhill Medical Trust and began in November 2023. https://ageingstrokeresearch.org/research-projects/include/ The research team are based in the Academic Unit for Ageing and Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust/University of Leeds.
