Survey results
Nineteen service users completed the survey: 13 men, four women, and two people who did not specify gender. There was a propensity for social/council housing (63.2%, n = 12), many lived alone (68.4%, n = 13) and had attended high school/college (94.8%, n = 18). They were also mainly over 40 years of age (78.9%, n = 15) and lived in a city (68.4%, n = 13). There were 94.7% (n = 18) who identified as having long-term physical and mental health conditions and almost three-quarters, 73.7% (n = 14), possessed school-level education, and just over one-fifth, 21.1% (n = 4), had attended college. Table 1 provides participant demographics.
Phones were the most popular device with 100% of those who responded (n = 18) indicating they could access a smartphone. The second most popular was a tablet, with 50% of responding (n = 9) participants having access and there were also mentions for laptops, desktops, watches, and voice assistants. The majority had daily connections to the internet on their phones (84.2%, n = 16) with 57.2% (n = 8) having a constant home internet connection. Contacting family and friends was the most prevalent use for devices with 70.6% (n = 12) using text messages, 43.8% (n = 7) using social networking, and 22.2% (n = 4) using video calls. Table 2 provides an overview of the use of technology.
Additionally, devices were routinely used for health and social needs with over two-thirds, 68.4% (n = 13), highlighting the use of these services. Internet searches were accessed daily by 35.3% (n = 6) and 63.2% (n = 12) indicating they searched for information or help on drug use. However, 23.1% (n = 3) preferred face-to-face contact and were wary of digital technology due to privacy and broader societal trust issues. Other data highlighted a need to build confidence (38.5%, n = 5), and trust (23.1%, n = 3) in using digital technology. In addition, cultivating users’ knowledge of digital technology and its benefits was emphasised by over half of those engaged (53.8%, n = 7). Half (50%, n = 9) were also interested in refining their basic computer skills (18 replies) and 52.9% (n = 9), considered a good understanding and proficiency using the Internet to be the most valuable (17 replies).
Interview results
Twenty-one interviews were conducted with service users, with one being subsequently withdrawn due to concerns over the participant’s vulnerability. The findings are presented as three themes, related to the ‘Technological’, ‘People’, and ‘Organisational’ domains of the TPOM and the subordinate sub-themes that evolve from them.
Technology
Three sub-themes were identified in relation to ‘Technology’: cultivating connections; lack of technical knowledge; and usability as a key enabler or barrier of digital technology.
Cultivating connections
The advantages of digital technology enable individuals to connect with others, including friends, family, and support services. This connectivity offers a wide spectrum of support, from combating feelings of isolation and renewing connections with family and services to forming new friendships and improving self-esteem. This participant demonstrates the salience of accessible connection to others through the provision of a digital device:
Aye [yes]. No no, because before I got the iPad and that, I was just… I wasn’t really connecting with people, if you know what I mean. It made me feel more connected with people. (Participant 1)
Another participant emphasises that access to devices and social media has improved their situation and contact with their social worker:
It makes me feel much better because Facebook and all that, looking up things as well, and also with my like support worker kind of like sometimes emails me… or he’ll sometimes send me on my Facebook “right I am here, come and get me”, whatever. He has, if he can’t get hold of me, he will like just like text me or something. (Participant 14)
This participant highlights the benefits and positive impact of potential connection with their mother and the emotional context involved with their mother, even though they are in poor health:
But I’d love to just phone my ma [mother] again and be able to see her [daughter], for her to see me, that I’m a’right [alright]. I look really terrible now because I’m no [not] well an’ that, but…. (Participant 13)
However, for others, digital devices already provide a conduit to family and friends that would otherwise be inaccessible:
Yes, I keep in touch with my daughters, I’ve got four daughters, I am only in touch with two. So, I keep in touch with my two daughters that I’m in touch with and obviously like my friends, my family, kind of things like that. (Participant 14)
Participants openly discussed the significance of digital devices and the impact they have made, or could make, in improving connections and accessibility to family members in particular.
Lack of technical knowledge and access
The lack of technical knowledge and access was underlined by participants when navigating the intricacies of new devices. Their previous experience involved basic and inexpensive analogue phones without internet provision. Furthermore, they suggest a potential fear of technology and historical lack of access but there is support and encouragement from others who are facing similar challenges:
Aye [yes], yeah, there’s a lot of women all together, it’s no [not] just me. I thought I was the only technophobe in here [laughs]. But there’s other women in here, they’ve just been used to having like the wee £10 Alcatel phones and stuff like that, wi [with] no internet access. So, we’ve kinda, there’s one or two o’us that arenae [aren’t] very good at it, so I mean we’ve been able to like just help each other out, and like send like picture messages to each other and do video calls and stuff like that. (Participant 9)
Additionally, participants highlighted how a lack of access to the internet was addressed through connection to the online resources provided by the programme. It improved their confidence due to the help and advice offered by staff members:
They want to like send you stuff through and that, and I’ve got that, I couldn’t access that because I didn’t have any internet. So that’s been good, you know what I mean. And then [staff member] and [staff member] showing me, giving me the confidence, how to look up things, how to do that. That’s really helped. (Participant 9).
I had support with how to use it and that. The person who came out and gave me the laptop set it all up for me and gave me support for it. I got support they gave me. It’s just difficult starting off and getting it all set up and that. But once it was set up it was fine really, as long as they set it up for you and show you what to do, kind of thing. How to go into… and kind of within me, but once I got used to it, it was alright. (Participant 2)
Participants talked about the difficulty encountered when initially receiving their digital devices but were happy to receive the support of staff when installing the laptop and were then able to navigate the remainder of the learning process.
Usability as a key enabler or barrier of digital technology
Although benefits associated with technology provision were realised, the usability of the different devices, digital technologies, and applications was varied, depending on individual circumstances and experience of technology. The benefits of online communication using technology (such as tablets) were highlighted as it assisted in engaging with a broader range of people:
Basically, because I couldn’t get Zoom on my phone but I can do it with the iPad, so the iPad’s helped me communicate with a wider, with people from [location], people from [other location] and everything like that, so it’s getting me connecting with other people. (Participant 19)
Additionally, access to educational devices such as a computer and the learning that they have been engaging with at college were described as beneficial:
I’ve been learning on an actual computer rather than a thingummy [tablet], you know what I mean, like folder and all that and saving all my stuff in it. I’ve been learning how to do that at college. (Participant 17)
These participants both expressed different preferences and feelings and benefits associated with devices offered by the programme. They indicate that some devices are preferable to others, depending on individual predilection, situation, challenges or perhaps educational ambitions.
People
A number of themes were identified within the People factor. These were: digital technology as a connection to community; data privacy; apprehension around engaging with digital devices; and individual support incentivises engagement.
Digital technology as a connection to improve wellbeing
Participants talked about digital technology as a vehicle to providing and creating connections, which would increase social cohesion, confidence, and relationships. This highlights the important connections made online, enhancing a feeling of community which can help marginalised individuals build confidence and make new connections when they meet in person:
The day I kind of walked in the door at the community, I never really knew anybody. [Now] I know tens, do you know what I mean? Aye [yes], that is like you mentioned, the Zoom meetings and that, I get to know people that way and then when you meet them in person, you have kind of broken down a barrier. (Participant 1)
Another participant talked about digital connection and the opportunity to engage with services that were previously problematic such as mental health:
If you connect, that word keeps coming in, if you connect a lot better especially with mental health it’s a big thing the now. Especially for men. Men are embarrassed if they’ve got anything to do with mental health. (Participant 19)
Similarly, participants also described how talking to and connecting with people through devices is crucial for their continued wellbeing and interaction with each other and society. Using the phone to ask for support is highlighted below:
Well, if you’re feeling down or anything you can pick up the phone and speak to somebody. It’s good, cause you get to talk, no what I mean. So that is a good thing, you can get to talk… [if you’re] bothered by anything you can just talk about it. (Participant 11)
Furthermore, this next comment suggests the previous lifestyle experienced was a contributing factor to the need to find support from others through digital connection:
And you definitely need that, especially if you’ve been involved in my lifestyle. The one thing you need is people. And that’s one thing the iPad does offer, a way of connecting with people. (Participant 4)
These comments indicate that digital connection through various devices has a positive impact on wellbeing. Improving confidence and access to peer support and services is, they feel, crucial for improving their lives.
Data privacy
Participants highlighted that service users regularly feel unfairly scrutinised, judged, and stigmatised by society. There appears a deep-rooted unease when engaging with mainstream society and how service providers or stakeholders approach service user engagement, such as research projects, may be viewed as disingenuous or even nefariously motivated. This was evident in particular around the use of people’s data. Service users were apprehensive about providing any location or privacy information; speculating that this data would be used to monitor or covertly oversee their behaviours:
I was thinking myself, well, can you see where I am all the time? Or stuff like that. That and all just ways you can, I don’t know, I don’t really know if there is anything gaun [going] on behind the scenes about data or whatever… There has been women that have said that “oh, is that just to check up on us?” So, a lot of women start thinking, “Well, why are we getting these phones? Is that to keep tabs on us?“. (Participant 9)
Concerns were also raised over personal information being misused, however participants did not specify by whom:
I don’t see the point to it. All you’re going to do is access people’s personal information and just use it against them. (Participant 7)
Participants were apprehensive around data privacy, and it being shared with others for purposes out with the remit of this study. This particular cohort live lives on the margins of society where suspicion of people, places, and things is ever present. Without reassurance and guarantees that data privacy will be respected, engagement with these devices would be difficult.
Apprehension around engaging with digital devices
Participants highlighted a fear of the unknown and a lack of knowledge and confidence in using digital devices. This may cultivate a propensity to disengage from any benefits of digital technology that are in conflict with a life living in the shadows or more explicitly off the grid:
Well certainly we know not everybody wants to access the digital world and now I don’t know if that’s the fact that they want to be off the grid and they don’t, they understand digital and don’t enjoy it and choose not to. Or it may be that there’s a fear of the unknown and just say they don’t want to because they don’t know how to work [it] or maybe don’t understand the benefits it can bring as well. (Participant 12)
This suspicion of digital technology can be attributed to a number of reasons, for example, due to unfamiliarity with digital devices, sceptical of the benefits available or wishing to be ‘off the grid’ [30]. Some participants were more vocal when conveying their preference to engage face-to-face rather than through an online medium:
Aye [yes]… in person but I would do it online as well, but it is better in person, definitely better in person because you are face to face with that person. I mean, that’s just my thoughts anyway, I would rather do it in person but doing it like this, I don’t like doing it like this, but I don’t mind. (Participant 3)
This participant highlights the importance of retaining the option of providing face-to-face contact with those who are marginalised or vulnerable. They appear to indicate their belief that it is a more effective method of engagement.
Individual and collective support incentivises engagement
Person-centred incentives and support, which promoted individual solutions, were welcomed by the participants due to their diverse and distinctive challenges. Some participants appeared impassioned over their interactions with, and support received from staff. The staff/service user relationships provided the greatest assistance to digital use both personally and socially. This participant suggests that person-centred support incentivised engaging with services and using digital technology. There was motivation to learn and to return to engage further with service providers:
Yes, the staff in the hub, if you need any help with anything, you come in. Maybe one specific member won’t know but there’s always going to be somebody that will be able to help you, be it with your emails, be it with downloading something, be it with just using and setting it up. I’ve seen the staff helping each other in here with things. (Participant 15)
Other service users highlighted both interactions with community staff and collective peer support and friendships important to their engagement with services:
Well, a lot of the workers, I know a lot of the workers in here, and I get a lot of support … It’s brilliant in here. (Participant 8)
The camaraderie and support are further described below with the reacquaintance of the participant and a former friend. They state that they, along with new friends in the group, get on very well with each other:
Aye [yes], I’ve met a lot of new lassies [women], like friends. And a lassie [woman] that know that used to stay in [Location] when I stayed there years ago, I met her again. And it’s good to see her after 20-odd years, d’you know what I mean. And then like I’m pals [friends] with a lot o’ [of] the lassies [women] now, and we all get on brilliant, so really good. (SU8).
These participants have highlighted the individual and collective support received from staff and fellow service users as a crucial tenant of their continued engagement with both physical and digital services.
Organisational
People and organisational factors appear to enjoy a synergetic overlay. The two sub-themes in the Organisational domain have similarities with those on the People domain. These sub-themes are digital and personal support, and harm reduction with access to digital services.
Digital and personal support
Service providers played a key role in digital uptake. The friendly and genuine interest in service users was critical to ensure a welcoming, community environment:
[Service] definitely needs to be here. It is the heart of the community, like as in the homeless community. And it’s, it’s so unusual, pure joy, because it’s like… when you’re lost, and you can just chat to somebody. You’ve always got someone to bond wi [with] in here. (Participant 7)
Service providers were perceived as creating a safe space to feel at home, who respect and understand participants’ daily struggles. These frontline communities provide a mixture of trusting and helpful services, camaraderie, and support from peers:
So, we’re doing a lot of things with the women’s group just now that are digital, and it’s really like you can phone, you can look up things, and get a bit o’ [of] support. Like we’re doing meetings, drug meetings and stuff like that, cause you can go onto Zoom and do this for various meetings and stuff like that. So it’s instead of coming in here for support all the time, even though I have got a worker, if I’m like finding dealing with stuff fae [from] court and having a really bad day and stuff like that, I can like look, see what meetings are online, try and join something, and just try to keep connected wi [with] people who are going through the same kinda [kind of] thing. (Participant 9)
Taking the time to introduce service users in a way that builds confidence in digital services and devices has really helped the participants. Furthermore, it appears blending personal support with access to digital devices and connection is providing a positive community experience.
Connecting through harm reduction and access to digital services
Person-centred harm reduction benefits were evidenced here through access to group support and digital services for service users which provided connection and a sense of improved wellbeing. This participant stated they were attending a harm reduction course and enjoyed the focus on finding individual solutions. They are also using this to help connect with others. In this case, harm reduction appeared to enjoy a concomitant synergy with digital solutions as they both complement each other tackling the potential for negative outcomes and improving self-esteem:
That was when I’ve been going to the women’s harm reduction course. But I’m going to the [service provider] course as well. So, that’s going to be good as well because they said they’re gonnae [going to] do like things that’s reflecting different people’s outlook and stuff that’s happening… I’ve only started [with] the [service provider], but that will be good because I’ve got my data, and I know I can like connect with them as well. (Participant 9)
This was further explored with the discussion on harm reduction apps and the potential for instant updates and access to information. Two participants felt that the synergy between harm reduction and digital solutions was a positive development. This first one is optimistic over the potential to provide instant messages for harm reduction through a phone:
So it’s good if the service provider] are able to give them a phone. And then, as I said, we did that app. And that sends a message through on harm reduction, and let’s say for drug use, other misuse and stuff like that. (Participant 14)
While this second one illustrates the mileage in providing this for the younger generation to enable a more harm reduction focused and empowered approach from them:
It would be [harm reduction apps useful], especially the young generation at this point because there’s a lot of them don’t even have a clue when they’re taking ODs [overdoses] and all that. I’ve been there with the drink; I know what it’s like. (Participant 9)
These two participants demonstrate an appetite for instant advice and access to information detailing potential issues with the local drug supply. These digital harm reduction methods provide instant information, support, and reassurance to service users.
Overall, data from all interviews suggested that connections, in multiple forms, were seen as crucial to personal progress. Device usability, ensuring suitability, acknowledging disability, harvesting knowledge, providing education, building confidence, and protecting privacy were all identified as key areas of concern.
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