The first year of the DigiIN project has now passed – coronavirus cancelled encounters but made it clear how important it is to prevent digital exclusion

The DigiIN project received a funding decision at the end of June 2019. Our first year of operation consisted of a productive start in the autumn and unexpected changes in the spring as the coronavirus epidemic hit us.  Twice a year, we report impact stories to the Strategic Research Council to describe the progress of research and influence work and any changes to plans that were made along the way.

We summarised some of the contents of the impact stories in this first-year report.

Aiming to include everyone in an increasingly digitalised society

The DigiIN project is part of the Strategic Research Council’s CULT programme (Culture in an Increasingly Technologically Driven Society), and it seeks to answer a specific question of the programme: How to support the interaction between technological advances and culture to ensure the inclusiveness of an increasingly multicultural and technologically driven society?

DigiIN has three major objectives: a reform of the service culture in the social and healthcare sector, guaranteeing better electronic services for everyone, and preventing the exclusion of people who are the most vulnerable.

A new service culture in the social and healthcare sector

Digital self-care services, information systems and the related competence play an increasing role in the work of social and health care professionals. Poor usability of information systems is a growing source of stress for professionals, and this problem does not appear to be lessening. Furthermore, new self-care services, artificial intelligence and robotisation require professionals to adopt a new role and new operating methods.

Professionals and organisations have to change their work processes, professional identity and service culture, and they need to be supported during this change. We will look for ways to provide this support, and we are investigating many phenomena associated with digitalisation, such as information chaos, digital stress, acceptance of change, and learning needs.

Better electronic services for everyone

Using electronic services is often the most difficult for those who need them the most. We want to determine how electronic health and welfare services can be designed in a way that makes them easily accessible, usable and cost-effective for everyone.

The goal is to ensure that all user groups have smooth and equal access to services in a way that meets their needs. With the help of design, we aim for the services to achieve a good user experience that encourages people to manage their own health and well-being.

Preventing the exclusion of vulnerable people

Our aim is to prevent the exclusion of vulnerable people, such as the elderly, immigrants, and socially marginalised people. We will produce information about everyday problems, concerns and needs related to digital services, as well as ways to overcome them by means of various support services.

We will pay special attention to the role that individual, social and structural factors play in the emergence of problems and in their solutions. We will also find out how our largest immigrant group, Russian-speaking people, use digital technologies and services.

We will investigate the ways in which older age groups use digital services and the connection between digital technologies and older people’s satisfaction with life and perceived health.

We want to influence the working culture of people working with people with substance abuse problems, prisoners, and mental health rehabilitees to better support these groups in the use of services. We will also investigate the digitalisation of prisons and its significance for the work culture in the criminal sanctions field and desistance from crime for prisoners being released.

We will create and implement new solutions that engage marginalised groups of people in using digital services and make the services more easily available and accessible.  Another aim is to develop new pedagogical models for the social and health field in education provided by universities of applied sciences.

Reaching goals with impactful encounters

On 11 November, we organised a kick-off seminar at THL. The open seminar attracted a great deal of interest in various organisations and several ministries. In addition to presenting the DigiIN project, the seminar included discussions on the current situation of the digitalisation of social welfare and health care services and how digitalisation has affected client work in these services.

We held the project’s first steering group meeting on the same day. The project has a large and committed steering group that has, for example, helped to specify the different groups of people who need support and what their service needs are.

During the first year, we established a framework for the project communications by setting up a visual design, website and Twitter account. In addition to traditional research news, we have presented different perspectives on the digitalisation of social welfare and health care services in blog posts. The posts have been written by the researchers involved in the project but also by the members of the steering group and many others.

In the early stages of the project, it has been important to establish contacts with stakeholders and to present the significance of digital transformation in the social welfare and health care sector. During the past year, the research groups of the different work packages included in the DigiIN project have presented the challenges of digital services and the objectives of solving them in several events for many different target groups.

One of the most important target groups of the project is social welfare and health care professionals. We reached out to them at events such as JHL’s social welfare and health care festival, where we discussed the progress of digitalisation in elderly care within social and health care, and the challenges that digitalisation poses to the working and service culture.

At the PPSHP training day on 5 September 2019, Tarja Heponiemi and Sari Kujala discussed digital health care services in the everyday life of municipal residents and in the work of professionals (Terveydenhuollon digipalvelut kuntalaisten arjessa ja ammattilaisten työssä). The training day included topics such as stress and strain related to information systems in the social welfare and health care sector, the usability of information systems, and competence related to information systems. In addition, the day included discussions of the recommendations on the utilisation of digitalisation for organisations and management.

In the Criminal Sanctions Agency’s Smart Prison seminar on 19 November 2019, Teemu Rantanen presented preliminary results from a study whose material has been collected by interviewing persons with a criminal background in different parts of Finland.

DigiIN has also actively interacted with international partners.

On 23 August 2019, we held an open seminar called Medical decision making and motivating people in using digital health with Professor Talya Miron-Shatz from Israel as speaker. We planned future international cooperation with various parties at the MedInfo conference held in France 27–30 August 2019.

Sakari Taipale gave a lecture at the joint international conference of the University of Nantes, Nantes University Hospital, VTT and Orton Hospital on 9 October 2019. The lecture discussed how health care service culture should take account of the varied digital skills of older people and cultural diversity.

DigiIN contributed to the discussion of the needs of older people as users of digital devices and services at events such as the 14th European Sociological Association (ESA) conference in Manchester. We also organised an international AgeCare DigiIN workshop called Conceptualizing and theorizing health and social services in digital society in Jyväskylä. We invited several stakeholders, including KSSHP, JAMK and the City of Jyväskylä, to attend the open lectures and discussions. Several new international contacts were also made at the workshop. An international book project has been launched on the basis of the workshop in spring 2020.

International cooperation was also strengthened during Sari Kujala’s researcher visit to the health & life sciences university UMIT in Austria 18–13 December 2019.

Providing information to support decision-making

We participated in discussions on the digitalisation of services at an electronic service seminar organised by the inspection boards of the Helsinki Metropolitan Area. The topic is based on the joint evaluation of electronic health services by Espoo, Helsinki, Kauniainen, Vantaa and HUS. Participants at the event were very interested in our preliminary results, and we were able to formulate new research questions based on the discussions.

A member and an alternate member of the DigiIN project were invited to the “Digi arkeen” advisory board for the period 2020–2023. The advisory board was initiated by Minister of Local Government Sirpa Paatero and appointed by the Ministry of Finance. The objective of the advisory board is to support the development of digital services so that different population groups will have equal access to the opportunities that digitalisation creates. Project representatives in the advisory board are Tarja Heponiemi as member and Sari Kujala as alternate member.

The advisory board has held its first meeting and, when considering the tasks of the advisory board, we have expressed the important themes of the DigiIN project. The tasks of the advisory board include organising round table conferences, making statements, and influencing official matters such as government programmes.

One connection with an important stakeholder was strengthened at the beginning of the year when Anne Kouvonen became a member of the board of directors of the A-Clinic Foundation on 1 January 2020.

Expertise of digital exclusion in educational content

One of the objectives of DigiIN is to support the creation of a new kind of digital service and work culture through educational content. The project group lent their expertise at the new Master’s Programme in Social and Health Research and Management that began at the University of Helsinki in autumn 2019. Anne Kouvonen served as an expert member of the programme’s management group during the autumn. The programme educates future social welfare and health care managers, and it has immediately become the most popular master’s programme at the University of Helsinki.

At Laurea University of Applied Sciences, students have been able to familiarise themselves with the themes of DigiIN, and related student works include a literature review of the digital services of substance abuse rehabilitees. The DigiIN project includes ongoing theses both in the criminal sanctions and the social welfare sector.

Need for service users’ digital support highlighted by the coronavirus epidemic

During the coronavirus epidemic, the DigiIN project has been more topical than ever: the epidemic forced a completely new pace of digitalisation. In the news and blogs, we have highlighted the situation of groups at risk of digital exclusion as well as the sources of support that are available.

The Age Institute is also involved in the project, and we were able to use the blog to highlight their concept that is excellent for this situation: remote exercise for the elderly. The service has in fact garnered a lot of interest, and the view counts of exercise videos doubled in just two months compared to previous years.

In December 2019, the Age Institute received funding from STEA for the organisational development of the remote exercise for the elderly. The funding has been used to develop the concept of remote exercise in such a way that the needs and realities of organisations can be taken into account better than before. The remote exercise for the elderly and the related follow-up study were also presented at the Age Institute’s Strength in Old Age seminar on 5–6 February 2020 in Helsinki. The event had approximately 200 participants: representatives of municipalities and other stakeholders who promote physical activity among the elderly in Finland.

Laurea University of Applied Sciences also decided to conduct phone interviews both to find out about the digital experiences of the elderly and to provide a welcome distraction for the interviewees during the coronavirus restrictions. Five students studied the concept of digital exclusion, the provision of services for the elderly, and the means of service guidance and management. In addition, they conducted 31 telephone interviews with elderly people and analysed the interviews.

Meeting and data collection plans changed due to coronavirus

The coronavirus pandemic changed the plans for the DigiIN project in many respects.

Several events that would have been valuable for meeting stakeholders, such as TERVE-SOS and an IT event for healthcare (Sote Atk-päivät), had to be cancelled. So, to increase interaction, we published more news and blog posts and made an effort to be active on Twitter.

The project’s internal communications were also moved over to remote meetings, and the planned meeting of the research groups of different work packages was postponed.

Due to coronavirus, a seminar on the availability of services in the digital age planned for March was also postponed. Postponing the seminar turned out to have a positive effect as well: we quickly received many more registrations than we could have fit in the space that had been reserved. We will postpone the seminar until the autumn and organise it as a webinar, so that we can better respond to people’s interest.

The timetables for some data collections also had to be changed, or the implementation method had to be changed from face-to-face meetings to remote connections.

Research extracts from the first year

During the first year of the DigiIN project, we published 10 peer-reviewed scientific articles and 8 other publications, such as student theses.

We have analysed existing materials and published international articles on them.

We compared the usability experiences of information systems in different professions (doctors vs. nurses) and found that doctors were more satisfied with the technical quality and learnability of the systems, while nurses considered the systems to be easier to use and found them to support cooperation better compared to doctors. We found that patient information system labels used in hospitals supported doctors’ work better, while labels used at health centres met nurses’ needs better.

We have analysed and identified challenges and competence needs related to the introduction of electronic self-care services and, in particular, the role of supervisors.

At the moment, we are analysing and writing international scientific manuscripts on how information overflow, the availability of electronic systems, the psychosocial work environment and well-being at work are all linked for social welfare and health care professionals. We aim to identify protective factors that support the well-being of social welfare and health care professionals and, on the other hand, to increase awareness of what factors increase vulnerability to poor well-being at work in an increasingly digital environment. Among other things, we will examine the importance of the social and IT support provided by workplaces for the use of electronic services and digital tools in home care.

Preliminary results show that especially young nurses are at risk of experiencing strain related to information overflow in their work. We found that young nurses who find it difficult to use electronic patient information systems make more cognitive errors in their work compared to older nurses.

However, the user-friendliness of electronic systems can protect young nurses from this strain associated with information overflow. On the other hand, changes or failures in electronic systems are particularly straining for older nurses. However, this strain is considerably reduced if the systems are user-friendly, and it has been found that user-friendliness protects both the young and older nurses from strain associated with changing systems.

Our preliminary results indicate that poor system usability and strain caused by work diminish the benefits gained by using electronic systems. This means that the benefits of using these systems are not only dependent on usability factors but the characteristics of the working environment as well.

In addition to the abovementioned, we are studying the competence of nurses who have graduated in recent years (2016–2018) as well as those who have more work experience, and whether factors such as the year of graduation, age, work sector or geographical area are related to nurses’ competence. We will also use research to identify possible training needs related to the use of information systems.

Preliminary results show that newly graduated nurses have betters skills related to the use of information systems compared to those who have graduated a longer time ago. The results emphasise the importance of adequate continued education and support, especially for those nurses whose basic studies did not include information management very extensively.

We have also participated actively in the planning of surveys for the STePS 3.0 project. The objective has been to conduct extensive national surveys for doctors, nurses, social workers and citizens (as part of the FinSote survey) as well as health and social welfare organisations during this year. We aim to include some of the themes of the DigiIN project in the surveys. Due to the coronavirus epidemic, there have been some changes in the survey timetables.

In Jyväskylä, a survey on technology and the elderly (Vanhustyö ja teknologia 2019) was conducted with answers from 6900 employees working with elderly people.  The survey provides an up-to-date picture of the use of IT equipment and electronic services in the services and care for the elderly. In addition, the aim is to examine the significance of the use of digital technologies and their links with working conditions, daily work routines and care relationships. In addition, a panel will be formed of survey respondents in order to carry out follow-up surveys on the same persons and to monitor the nature and digitalisation of care work in 2019–2025 during the DigiIN project.

In March 2020, we collected the experiences, challenges and support needs of 151 professionals and their supervisors in nine hospital districts related to the Omaolo symptom assessment.

We have also interviewed the project coordinators responsible for the development and implementation of the Health Village’s digital treatment paths. Poor accessibility, compatibility issues, and missing functionalities proved to be common issues with implementation. Good practices were identified as continuous communication and the collection of feedback from both patients and professionals. The manuscript written on the results has been approved for the Journal of Medical Informatics.

The aim is also to start more in-depth qualitative case studies during the summer in four health centres that have introduced new working methods and forms of service that are based on digitalisation.

In the Multiculturalism sub-project, we have made observations and conducted interviews in autumn 2019 and early spring 2020 in two groups that offer digital support in Russian.

The CHARM (Care, Health and Ageing of Russian-speaking Minority in Finland) material has been collected and a basic report has been published. The publication of the report was planned for April 2020 but had to be cancelled due to the coronavirus pandemic. Several publications and theses are currently being produced from the CHARM material.

For the work package on supporting socially marginalised groups with the use of digitalised services, a research plan has been prepared in connection with sub-studies related to criminal backgrounds. Analyses of interview material related to criminal backgrounds have been initiated.

Our most recent published study on the FinSote material shows that those who are in a disadvantaged position in economic, health and social terms feel that they benefit the least from electronic services. In our study, digital competence emerged as the most important factor explaining the benefits of electronic services.  The risk of exclusion from services and the deterioration of welfare is particularly high for groups already in a vulnerable position, which is why, based on the results of this study, it would now be important to invest in improving the digital competence of groups in particular at risk of digital exclusion.