Table 4 Determinants of health relevant for pain equity
Determinant of health | Examples of social determinants of health How social determinants may impact people’s perception, behaviour and attitude towards pain and pain management services | Examples of digital determinants of health How digital determinants may impact people’s use and adoption of digital pain self-reporting tools |
|---|---|---|
Age | “there is an expectation of pain as you get older, and you accept that you will have pain” (Male patient participant; FG with older adults) | “It’s…to do with trust as well…some older adults will have a lot of fear built around using digital devices and giving away too much personal information” (Researcher working with older adults; FG with older adults) |
Gender | “I think a lot of people might hesitate because you do get pain in those [private] areas but you don’t know how to explain, how to express” (Female patient participant; FG with ethnic minorities) | |
Ethnicity | “[in certain cultures] because they would be basically disclosing how they feel to their family members….Once they disclose, then word gets out within the family very quickly and it puts them in a psychologically very weak state potentially” (Male patient participant; FG with older adults) | |
Social and community networks | “so if you download the app but you get stuck is there somebody around you can go to get support with that” (Researcher working with older adults; FG with older adults) | |
Language | “I think a person's first language or language that they're most comfortable in can make an impact on [sort of] navigating health services” (Female patient participant; FG with people living in deprived areas) | “…a translation element of the digital solutions that could help those whose language isn't their first language English” (Female patient participant; FG with people living in deprived areas) |
Socio-economic status | “..there a risk of increasing frustration by something like this tool [digital pain self-reporting] highlighting to you the inequalities in your own circumstances…….if you run out of data or your phone isn't very good” (Female patient participant; FG with people living in deprived areas) “So people with chaotic backgrounds, chaos within their lives, I think are very much marginalised….the last thing that they can afford usually is an internet” (Female patient participant; FG with people living in deprived areas) | |
Privacya | “….you're in shared accommodation and you don't have privacy to sit and do it [digital pain self-report]” (Female patient participant; FG with people living in deprived areas) | |
Confidentiality | “the reason why people tick the 'Do not want to say' box is because they feel Big Brother's watching them and something negative is going to come out of being part of a research or ticking a box or giving information about themselves” (Male patient participant; FG with ethnic minority group) | |
Healthcare services | “But that will stop people reporting [pain] because they have low expectations of results from their just verbal communications with medical professionals” (Male patient participant; FG with older adults) | “For some of the older adults they felt that being online was a negative loss of social interaction. So they enjoyed going to the doctors, they enjoyed the social connections that were made through face to face visits” (Researcher working with older adults; FG with older adults) |