Technology push without a patient pull: Examining digital unengagement (DU) with online health services

Purpose: Policymakers push online health services delivery, relying on consumers to independently engage with online services. Yet, a growing cluster of vulnerable patients do not engage with or disengage from these innovative services. We need to understand how to resolve the tension between the push of online health service provision and unengagement by a contingent of healthcare consumers. Thus, this study explores the issue of Digital Unengagement (DU) (i.e., the active or passive choice to engage or disengage) with online health services to better inform service design aligned to actual consumer need. Methodology: Adopting a survey methodology, a group of 486 health services consumers with a self-declared (acute or chronic) condition were identified. Of this group, 110 consumers were classified as digitally unengaged and invited to write openended narratives about their unengagement with online health services. As a robustness check, these drivers were contrasted with the drivers identified by a group of digitally engaged consumers with a self-declared condition (n=376). Findings: DU is conceptualized and four levels of DU drivers are identified. These levels represent families of interrelated drivers that in combination shape DU: Subjective Incompatibility (misalignment of online services with need, lifestyle and alternative services); Enactment Vulnerability (personal vulnerabilities around control, comprehension and emotional management of online services); Sharing Essentiality (centrality of face-to-face co-creation opportunities plus conflicting social dependencies); Strategic Scepticism (scepticism of the strategic value of online services). Identified challenges at each level are the mechanisms through which drivers impact on DU. These DU drivers are distinct from those of the digitally engaged group. Research Implications: Adding to a nascent but growing literature on consumer unengagement, and complementing the engagement literature, we conceptualize DU, positioning it as distinct from, not simply a lack of, consumer engagement. We explore the drivers of DU to provide insight into how DU occurs. Encapsulating the dynamic nature of DU, these drivers map the building blocks that could help to address the issue of aligning the push of online service provision with the pull from consumers. Practical Implications: We offer insights on how to encourage consumers to engage with online health services by uncovering the drivers of DU that, typically, are hidden from service designers and providers impacting provision and uptake. Social Implications: Associated with the generic policy emphasis on pushing online services is concern over the unintentional disenfranchising of segments of society. We shed light on the unforeseen personal and social issues that lead to disenfranchisement by giving voice to digitally unengaged consumers with online health services. Originality/Value: Offering a novel view from a hard-to-reach digitally unengaged group, the conceptualization of DU, identified drivers and challenges inform policymakers and practitioners on how to facilitate online health service (re)engagement and prevent marginalisation of segments of society.