Developing user personas to capture intersecting dimensions of disadvantage in marginalised older patients: a qualitative study.

BACKGROUND: Remote and digital services must be equitable, but some patients have difficulty using these services. Designing measures to overcome digital disparities can be challenging for practices. Personas (fictional cases) are a potentially useful tool in this regard. AIM: To develop and test a set of personas to reflect the lived experiences and challenges that disadvantaged older people face when navigating remote and digital primary care services. DESIGN AND SETTING: A qualitative study of digital disparities in NHS community health services offering video appointments. METHOD: Following familiarisation visits and interviews with service providers, 17 older people with multiple markers of disadvantage (limited English, health conditions, poverty) were recruited and interviewed using narrative prompts. Data were analysed using an intersectionality lens, underpinned by sociological theory. Combining data across cases, we produced personas and refined these following focus groups involving health professionals, patients and advocates (n=12). RESULTS: Digital services created significant challenges for older patients with limited economic, social and linguistic resources and low digital-, health-, or system-literacy. Four contrasting personas were produced, capturing the variety and complexity of how dimensions of disadvantage intersected and influenced identity and actions. The personas illustrate important themes including experience of racism and discrimination, disorientation, discontinuity, limited presence, weak relationships, loss of agency and mistrust of services and providers. CONCLUSION: Personas can illuminate the multiple and intersecting dimensions of disadvantage in marginalised patient populations and may prove useful when designing or redesigning digital primary care services. Adopting an intersectional lens may help practices address digital disparities.