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Smartphone barrier: uncovering the digital divide in mHealth prevention among disadvantaged middle-aged and older-aged UK communities
Brooks Rachael, Hoevenaar-Blom Marieke P, Coley Nicola, Moll van Charante Eric P, Barnes Linda, Richard Edo, Brayne Carol. BMJ digital health & AI, 2026-09-09
Topic: Risk, prevention and care in population studies
Plain-language summary
To investigate the response to an invitation to participate in a blended mobile Health intervention among adults living in deprived areas. Secondary analysis of recruitment data from a randomised controlled trial. A primary care population from disadvantaged geographies in the UK. Individuals in mid-to-late life at increased risk of developing dementia based on their risk profile. Invitation by letter from GP, followed by a text reminder by phone. (1) Response rate to the invitation. (2) Association of response with GP practice size, area-level deprivation and COVID-19 restrictions. (3) Reasons for non-participation.Univariate linear regression analyses were performed to assess the association between practice size and area deprivation (Index of Multiple Deprivation), with positive response rates per GP practice. The impact of COVID-19 isolation policies was assessed visually by comparing positive response rates across different restriction phases. Of the 13 814 invited participants, 12 816 (93%) did not respond. Of the 998 (7%) who responded, 690 (69%) were willing to participate (positive response), while 308 (31%) declined (negative response). Of the 308 negative responders, 209 provided a reason for not being willing or able to participate. The most frequently cited reason was the requirement to use a smartphone (40%), with 33% reporting they did not have a smartphone or internet access and 7% stating that they were unable or willing to use one. There was no association between response rate and COVID-19 restrictions on public life. In deprived areas, most people invited to participate in a dementia prevention study via their GP practice did not respond. Smartphone use emerged as a barrier to participation in this population. Our results suggest that major efforts are needed to reduce participation bias, increase generalisability of study results and address health inequalities in preventive interventions. ISRCTN15986016.
What this study adds
Evidence grade: High
This is a trial. This analysis of recruitment data found that 93% of invited participants did not respond, and the most common reason for declining was the requirement to use a smartphone. It is about participation barriers in a prevention trial, not about any treatment, cure, or prevention result.
Taken from this record’s own fields, not from reading the paper. The grade is assigned from the abstract’s wording; what that means.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Rachael, B., Hoevenaar-Blom Marieke, P., Nicola, C., Moll van Charante Eric, P., Linda, B., Edo, R., et al. (2025). Smartphone barrier: uncovering the digital divide in mHealth prevention among disadvantaged middle-aged and older-aged UK communities. BMJ digital health & AI. https://doi.org/10.1136/bmjdhai-2025-000069
Vancouver
Rachael B, Hoevenaar-Blom Marieke P, Nicola C, Moll van Charante Eric P, Linda B, Edo R, et al. Smartphone barrier: uncovering the digital divide in mHealth prevention among disadvantaged middle-aged and older-aged UK communities. BMJ digital health & AI. 2025. doi:10.1136/bmjdhai-2025-000069. PMID: 42712339.
BibTeX
@article{rachael2025-42712339,
author = {Rachael, Brooks and Hoevenaar-Blom Marieke, P. and Nicola, Coley and Moll van Charante Eric, P. and Linda, Barnes and Edo, Richard and Carol, Brayne},
title = {{Smartphone barrier: uncovering the digital divide in mHealth prevention among disadvantaged middle-aged and older-aged UK communities}},
journal = {BMJ digital health \& AI},
year = {2025},
doi = {10.1136/bmjdhai-2025-000069},
pmid = {42712339},
url = {https://doi.org/10.1136/bmjdhai-2025-000069}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 7 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
Key findings
- Individuals in mid-to-late life at increased risk of developing dementia based on their risk profile.
- Our results suggest that major efforts are needed to reduce participation bias, increase generalisability of study results and address health inequalities in preventive interventions.
Why it matters
This analysis of recruitment data found that 93% of invited participants did not respond, and the most common reason for declining was the requirement to use a smartphone. It is about participation barriers in a prevention trial, not about any treatment, cure, or prevention result.
New to this subject? Start with our plain-English guide: Risk factors, ranked →
Study details
- Study designrandomized controlled trial
- Evidence strengthHigh
How this study scored 51/100
Published in a peer-reviewed journal, and it is a randomized controlled trial. Scored zero for sample size, effect reported and studied in people because the record does not state it. We have no data on journal's citation record, so that was left out: it earned 49 of the 96 points we could judge it on, which is 51 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (BMJ digital health & AI) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 11 / 12 | A randomized controlled trial |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomized / blinded | 1 / 2 | Randomized (as stated in the record) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-17) |
| Citations per year | 0 / 5 | 0.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Carol Brayne: h-index 160 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Inserm: institution h-index 1,988 (OpenAlex) |
| Multicenter collaboration | 3 / 3 | OpenAlex lists 10 institution(s) in 3 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 42712339) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 49 / 96 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 49 of the 96 points we could judge it on is 51 out of 100. |
| Total | 51 / 100 | — |
What each of these 20 components measures, and what this score is not →
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