Confidence: a Key Determinant of Digital Health Use

Consider a new digital health tool you have just launched. You need patients to use it. You know that digital skills and health literacy are important. These are the baseline requirements so you make sure you factor that into the implementation. You launch and then pattern emerges. Despite your efforts, many patients never click through. Others login and then drop off after a fortnight. Some never make it past the login. We assumed that skills training was the key to use. But that only solves part of the problem. Because the barrier is not just capability. It is confidence.

This article examines digital confidence, what it is, what drives it, and why it must be assessed at the point of referral for any digital-first service. We will explore UK evidence and practice insights, with a core message: confidence is the hidden variable that determines whether digital health will be universally adopted, or only by a few of us.

Digital confidence refers to the belief and trust individuals have in themselves and the systems around them that influences their online engagement. The Good Things Foundation defines digital confidence as a multi-layered concept that goes beyond technical skills, encompassing trust, self-belief, and a sense of safety in engaging with the online world.

It emerges when people believe they can use a digital service safely, effectively, and independently, or know they will receive support if not. Confidence is built through prior success using similar tools, through trust in the system and the tool itself. It grows through technology usability that allows people to complete tasks without fear or friction.

In health contexts, confidence also means trusting the health system to protect your data, clarity on what's expected and what happens if something goes wrong, and belief that you'll receive care that is equal or better, not worse, than non-digital alternatives. If any of these fail, confidence collapses.

16% of UK adults lack Foundation-Level digital skills, this equates around 8.5 million people. Among people aged 75 and over, 49% cannot complete the eight essential digital tasks required to confidently use services online. Only half of UK adults report feeling confident in their digital skills, Future of Work, 2023. Confidence is lowest among older adults, people in deprived areas, disabled people, and non-native English speakers, precisely the groups most in need of healthcare and often targeted for digital-first approaches.

Trust and safety are foundational components of confidence. When users don't trust the technology, the provider, or the safety of their data use, they won't feel confident. A 2025 literature review found that privacy concerns and the belief that digital health is a cost-cutting measure, rather than a quality-improvement one, were key barriers to confidence.

Confidence increases when support is visible. Peer mentors, digital champions, onboarding calls, all of these make a measurable difference. The Health Foundation notes that human help increases engagement and satisfaction.

Context matters. People feel more confident when tools align with their health needs, language, and daily lives. Systems designed in isolation from lived experience often see low uptake. And finally, confidence among health staff shapes patient confidence.

A digitally hesitant workforce will reduce confidence in patients. A digitally fluent workforce builds trust. Digital confidence among the NHS workforce is a critical factor in successful digital health transformation, but there significant challenges in ensuring staff have the digital skills and confidence needed to fully leverage new technologies.

Design matters too. Poor interfaces can erode confidence even in tech-savvy users. The King's Fund highlights the importance of inclusive design shaped by continuous feedback from diverse users (King's Fund, 2024).

If we don't assess digital confidence at the point of referral, we risk pushing people into unsuitable pathways. This leads to disengagement, missed care, and widening inequality. We also might carry out wholesale exclusions if we believe, for example, all older people can't use technology and consequently exclude them from digital-first pathways.

When people trust the system, they are more likely to feel confident using it. When they feel confident, trust grows through positive experiences. For marginalised groups, historical mistrust in healthcare institutions compounds digital hesitancy.

Assess confidence early. Don't assume digital readiness, assess it. Brief validated questions at referral can identify who needs additional support before they disengage.

Provide visible human support. Digital champions, peer mentors, and onboarding calls all increase confidence and use.

Design with users, not for them. Co-design with diverse populations ensures tools are usable and trusted from the start.

Train the workforce. Clinician confidence drives patient confidence. Digital skills training for staff is not optional.

Measure and act. Track confidence alongside uptake. If confidence is low, adjust support, simplify design, or reconsider the pathway.

Confidence isn't vague. It can be measured, tracked, and improved. Tools like the Digital Confidence Scale exist. Using them at the point of referral allows us to match people to pathways they can succeed in, rather than pathways we want them to use.

Digital health works when people believe it will work for them. That belief, confidence, is shaped by design, support, trust, and prior experience. If we ignore confidence, we will continue to see digital health fail to reach those who need it most. If we measure and support confidence, we create systems that work for everyone.

The question is not whether digital health can succeed. It's whether we will design and deliver it in ways that allow everyone to succeed with it.