Adoption and Use of the NHS App in England: a mixed-methods evaluation

BACKGROUND: The NHS App was launched as a 'front door' to digitally enabled health services, offering a range of services including appointment booking and ordering prescriptions. The extent of App use and its impacts on digital inclusion is under-explored. AIM: To evaluate patterns of App uptake and adoption among different population groups. METHOD: Interrupted time series analyses explored aggregate monthly App usage from January 2019 - May 2021. Regression model assessed differences in App registration by markers of GP level socio-demographic variables. Qualitative interviews and focus groups involving 83 participants were conducted and analysed thematically. RESULTS: There were 8,524,882 App downloads and 4,449,869 registrations. Negative binomial models found 25% less registrations in the most deprived practices (P <0.001) and 44% more registrations in the largest practices (P<0.001). Registration was 36% more in practices with the highest percentage of White patients (P <0.001) and 23% more in practices with highest percentage of 15-34-year-olds (P <0.001). In contrast, App registration was 13% less in practices with highest percentage of males (P <0.001) and 2% less in those with highest percentage of people with long-term care needs (P <0.001). Qualitative evaluation found that the App was not perceived as relevant or accessible for all and there are important cultural considerations (for example, language barriers and some restrictions in symptom checking for non-White skin). However, it can enable patients to hold services accountable. CONCLUSION: There is high uptake of the NHS App but there are differences in adoption rates among different population groups and issues of relevance and accessibility, that warrant further work.