Colonial Privileges in a Settler Society: Disparities of Cultural Capital in a University Setting

Drawing on forty one-on-one interviews with third year students from The University of Auckland, this study contrasts the experiences of students from working- and upper-class backgrounds. In particular, the study demonstrates how working-class students, most of whom come from Indigenous Māori and Pacific ethnic backgrounds, are forced to navigate obstacles infused with interpersonal and institutional racism. These students also report a stigmatising awareness of their lack of privilege and sense of obligation to give back to their ethnic communities. In contrast students from upper-class backgrounds, though hard-working, discuss a litany of opportunities extending their academic and occupational privilege. These capital-building opportunities are tightly connected to consistent family support in the form of gifted money, flexible work options, and networks that enhance professional experience. Working with kaupapa Māori and Bourdeausian conceptual frameworks, the study highlights privileged students’ ability to access and extend their objectified cultural capital, as less economically privileged students work their way through colonial blockades and classed pitfalls. Given the clear disparities expressed by study participants, the research suggests universities radically reframe how resources are allocated to students from diverse backgrounds

Readiness for Delivering Digital Health at Scale: Lessons From a Longitudinal Qualitative Evaluation of a National Digital Health Innovation Program in the United Kingdom

Background: Digital health has the potential to support care delivery for chronic illness. Despite positive evidence from localized implementations, new technologies have proven slow to become accepted, integrated, and routinized at scale.Objective: The aim of our study was to examine barriers and facilitators to implementation of digital health at scale through the evaluation of a £37m national digital health program: ‟Delivering Assisted Living Lifestyles at Scale” (dallas) from 2012-2015.Methods: The study was a longitudinal qualitative, multi-stakeholder, implementation study. The methods included interviews (n=125) with key implementers, focus groups with consumers and patients (n=7), project meetings (n=12), field work or observation in the communities (n=16), health professional survey responses (n=48), and cross program documentary evidence on implementation (n=215). We used a sociological theory called normalization process theory (NPT) and a longitudinal (3 years) qualitative framework analysis approach. This work did not study a single intervention or population. Instead, we evaluated the processes (of designing and delivering digital health), and our outcomes were the identified barriers and facilitators to delivering and mainstreaming services and products within the mixed sector digital health ecosystem.Results: We identified three main levels of issues influencing readiness for digital health: macro (market, infrastructure, policy), meso (organizational), and micro (professional or public). Factors hindering implementation included: lack of information technology (IT) infrastructure, uncertainty around information governance, lack of incentives to prioritize interoperability, lack of precedence on accountability within the commercial sector, and a market perceived as difficult to navigate. Factors enabling implementation were: clinical endorsement, champions who promoted digital health, and public and professional willingness.Conclusions: Although there is receptiveness to digital health, barriers to mainstreaming remain. Our findings suggest greater investment in national and local infrastructure, implementation of guidelines for the safe and transparent use and assessment of digital health, incentivization of interoperability, and investment in upskilling of professionals and the public would help support the normalization of digital health. These findings will enable researchers, health care practitioners, and policy makers to understand the current landscape and the actions required in order to prepare the market and accelerate uptake, and use of digital health and wellness services in context and at scale

Large Scale Digital Health Deployments - How Ready Are We?: Lessons From the UK Delivering Assistive Living Lifestyles at Scale (dallas) Programme

Context: Digital health has great potential but has proven slow to become accepted, integrated and routinized at scale. Here we have examined factors affecting readiness to implement digital health at scale, through the evaluation of a national digital health and wellbeing programme called ‘Delivering Assisted Living Lifestyles at Scale’ (dallas, 2012-2015, $52M). Objective: To identify barriers and facilitators to digital health and to make recommendations about how to promote uptake of digital health. Design: Longitudinal (3 years) qualitative study involving Interviews (n=126) with key stakeholders; Focus groups (n= 7) with professionals/public using dallas services; dallas leads meetings (N=12); ethnographic field work/participant observation in one community (n=16); and cross programme documentary evidence (N=215) used to evaluate the implementation of the dallas programme. Normalisation Process Theory underlying conceptual framework. Framework approach to analysis. Setting: UK wide general population. Participants: Key stakeholders: health professionals, managers, IT staff, industry, voluntary sector, and the public. Results: Issues influencing readiness for digital health were noted at three levels: Macro (market; infrastructure; policy), Meso (organisational) and Micro (professional/public). Factors hindering implementation included: lack of IT infrastructure both locally and nationally; uncertainty around information governance; lack of incentives to prioritise interoperability; lack of precedence on accountability within commercial sector; a market perceived as difficult to navigate; inadequate implementation resources; low IT skills and access across users (professional and lay); and concerns surrounding security and safety. Factors enabling implementation included: clinical endorsement; digital health champions; and public and professional willingness to embrace digital health. Conclusions: There is receptiveness to digital health, but substantial barriers to widespread use remain. Recommendations include: greater investment in national and local infrastructure, implementation of clear systems for accreditation and quality assurance, incentivisation of interoperability, and investment in upskilling of professionals and public would help support normalisation of digital health