Three interconnected themes demonstrate how multiple aspects of a person’s identity and social position can create pathways of engagement towards or away from digital methods.

Digital Positionality: The Interplay of Social Position, Personal Experience, and Identity

Each participant appeared to have several interacting factors that shaped their relationship with digital methods.

The interactions between migration status, language proficiency, and age appeared to create roles that led segments of this population to be a digital supporter or digital dependent.

Younger second-generation adults with bilingual language skills tended to feel high levels of confidence engaging with a variety of digital technologies, and on reflection attributed this to their experiences in the educational system and contemporary social interactions. People with these characteristics shared how they would commonly fulfil the role of language and digital mediator for older immigrants with limited English proficiency in a health research context.

I know Punjabi. I explained the questionnaire, like I convert them. I say I explained it in my language so that they can understand. (34, male, Pakistani).

Many older adults saw technology as something for younger generations; second-generation adults, especially those living with or near their first-generation parents, seemed to feel a greater responsibility to support less digitally literate elders. This increased sense of responsibility may have been due to the need to navigate additional linguistic and cultural challenges or the expectation within their culture to respect and support elders.

I sent a video showing how turn your hot spot on..she calls me like 2 h later…screaming at me saying it’s not working. Where are you? Come home. And then obviously I’ll go a bit angry because I’m just trying to enjoy time with friends. I told her how to do it… it’s very annoying. (22, male, White and Asian).

Socioeconomic status and accessibility needs were strong interacting influencers towards people’s experience with several different digital methods. Those with greater financial resources spoke of having navigated physical needs, such as poor vision or dexterity, by acquiring multiple devices such as smartphones and tablets with larger touch screens. The ability to pick a device perceived to best suit a task appeared to help establish positive feedback loops of engagement.

Well, I haven’t actually picked up the phone because I’ve got Apple computer and Apple tablet and Apple phone, they all ping off at the same time when something comes in…. I prefer to have it on a bigger screen… (58, female, White).

Conversely, participants experiencing economic constraints often relied solely on smartphones, with a couple also mentioning a lack of software access (e.g. Microsoft Office) and compatibility issues. The most common frustration shared was the need to zoom in and consequently scroll sideways along sentences and down through large volumes of text.

I had to keep scrolling back to look at the questions and fill it in (35, female, White and Asian).

Home laptop access was largely limited to participants with employer-provided devices who in this sample were less likely to be experiencing socioeconomic disadvantage or have unmet accessibility challenges.

Findings also revealed how a person’s household role could interact with access to social support and age to create a particularly strong combination of factors that influenced behaviour towards or away from digital methods adoption.

Many participants reported how they or another member of the household were primarily responsible for the digital tasks in the household. In older adults, digital tasks were typically taken on by men, leading older woman to appear at a particularly high risk of having digital anxiety and low self-efficacy which seemed to further perpetuate their dissociation with technology and the use of digital methods.

People who experienced a disruption to these household roles (e.g. loss or divorce) seemed to face compounding risk of non-engagement due to low digital skills, lack of sustained in-person support from friends or family, and a disinterest in adopting behaviours that conflicted with their identity.

It [PC tablet] belonged to my husband…he was the computer one. (72, female, White).

This identity driven dissociation with digital seemed to result in little motivation to pursue or retain training or support.

Somebody showed me how to get on it once [NHS app] but I don’t use it. I don’t really want to know to be honest with you. (77, female, White).

Professional role transitions between digital and non-digital job demands, and retirement, emerged as a cross-cutting factor that had a strong influence on enhancing or diminishing engagement with digital methods. Some retired participants who expressed a level of confidence engaging with digital methods seemed to maintain skills and habits formed in their workplace, whereas others, especially where there was no perceived social or household need, experienced a disconnection from their former digital self.

I get up early and I get at it first thing in the morning, and I check my emails just like me when I was in my working days. (78, male, White).

These findings reveal how initial engagement with digital methods can be influenced by a relationship formed by a complex interplay of practical resources, social roles, and personal identities.

Power Redistribution in Research Relationships: Navigating Vulnerability and Agency

This theme explores how intersecting aspects of identity influence power dynamics across several digital methods, revealing how participants might navigate different communication methods in health research.

A combination of limited English proficiency and an unbalanced research staff-participant power dynamic was seen to create compounding motivators to engage with digital methods that enabled self-directed time to understand and process study information. It appeared that the largest challenges for this group were faced during in-person health research discussions, where participants seemed linguistically or culturally inhibited from seeking research related clarifications.

.. as a foreign national, probably my understanding will be slightly less than the native speakers, but you wouldn’t like to look like you didn’t understand… (37, female, other Asian).

A couple of participants with limited English language proficiency reported that verbal and written recruitment experiences were received in a way that did not help them feel able to easily understand the information being provided. Pre-conversation recruitment materials, particularly video-based resources with images, were a preferred first point of introduction to a study. Acquiring an initial understanding of the study was felt to preserve their sense of dignity during subsequent discussion with research staff. Face-to-face interactions with staff remained crucial for building trust; however, participants indicated a need for time to process the information post-conversation. The provision of digital written materials following verbal discussions enabled participants to easily store and customise the format of documents to facilitate better understanding (e.g. translation, creating space between text).

I do have some sort of issue with reading.. what’s been very helpful for me when it comes to the complicated text, is that I break them down into paragraphs and then make that on a big screen, and then read. That helped me process the information better…there are so many accessibility technologies are available on Google. (37, female, other Asian).

These findings highlight how digital methods can operate in a supporting capacity during the informed consent process; however, other participant accounts highlight how when used in other contexts digital methods can be perceived to protect or threaten a participant’s sense of control.

The intersection of socioeconomic position, gender, and professional identity shaped how participants negotiated their presence when using digital methods at home. For those without profession-derived digital identities, information exchange via video calls appeared to surface defensive behaviours due to insecurities relating to domestic space and self-presentation, with the latter being particularly present in women. These participants seemed to experience their home environments and at-home appearance as potential sites of judgement, revealing how video calls can unintentionally expose social hierarchies that would otherwise be protected during site-based visits or non-visual communications.

You do feel a sense of power imbalance a lot of the time. Whereas over the phone, it’s just the voice on the other end… It felt like I was talking to another person and not someone with a station or a position. (37, female, White).

Those with work-provided equipment and professional spaces at home often demonstrated a greater openness to video calls, whilst those relying solely on their mobile device which, in addition to the above-mentioned concerns, also caused ergonomic challenges (e.g. uncomfortable posture, balancing phone) reported favouring conventional phone calls for verbal communication.

There were a couple of cases where it appeared that a participant’s distance to the research team influenced information sharing behaviour. In one case, an older female participant described dreading research (questionnaire) phone calls. The participant appeared to have no rapport with the researcher and, due to what seemed to be provoked by a perceived social hierarchy, felt pressured to say what she thought the researcher wanted to hear. As a result, the imbalance in power dynamics appeared to provoke the provision of false information.

I took two [pain relief tablets], but I told her [research staff] I took one simply because… it was like ‘you will do this won’t you? (70, female, White).

In this case, the participant went on to share how she nearly left the study, and only stayed after being offered the option to provide data via postal questionnaires. For convenience, the participant would have preferred completing the questionnaires digitally, but (despite this being an option to others on the study) this was not offered to her. In this case, distance was seen to mitigate the potential influence of social desirability of participant-reported data.

Conversely, another participant seemed to use their physical and emotional distance from the research team to conceal a drug-induced rash and maintain her position on a trial. She suggested this would have been less likely to occur had she developed rapport with a staff member.

These findings indicate how digital methods have the potential to disrupt or exacerbate traditional social hierarchies depending on the context in which they are being used. They also highlight the complex balance that must navigate between ensuring proper safety oversight (traditionally achieved through in-person research visits) and the convenience that digital approaches may offer. Data accuracy presents a particular challenge—digital methods may reduce accuracy when participants lack a connection to the study or personnel running it yet simultaneously may enhance accuracy by reducing social desirability bias in participant responses. This multifaceted trade-off is likely to vary across study types, for example different considerations for high-risk interventional versus low-risk observational research.

Trust assemblages: how intersecting identities shape multi-modal verification practices in research engagement

DeLanda’s assemblage theory [37] focuses on the concept of assemblages as collections of heterogeneous elements that come together to form functional wholes. These elements can be both material (e.g. physical objects) and expressive (e.g. social practices, language).

This theory is relevant to this theme as it helps to conceptualise how different intersecting populations carry out different combinations of digital, physical, and social actions, referred to here as assemblages, to verify trust in a research organisation, study, or team.

Regarding remote invitations, posted letters were commonly seen by all as a more personal mode of communication and, seemingly due to their greater resource cost and lesser use in society, tended to leave an impression of importance. For many, the combination of a trusted sender and materiality of posted letters functioned as an importance and trust signifier that transcended digital immediacy, suggesting how physical methods can retain symbolic power as part of trust formation. Despite this, younger adults tended to feel that due to a lack of spontaneous availability or convenience, physical letters, although gaining attention upon receipt, were less likely way to evoke a response compared to their digital counterparts.

Whilst institutional markers such as NHS logos or university affiliations formed a baseline of initial trust for many, participants’ own positions appeared to shape how they navigated deeper connections with the research. Participants, particularly those invited to longer term or interventional research, sought out personalisation through individual address and sign off. Older females and ethnic minorities especially seemed to desire information that would help them construct the identity of the researcher.

A little letter of introduction… my name is XYZ. I’ve been studying at the university… something personal (70, female, White).

The intersection of age and cultural identity appeared to produce unique trust dynamics. Older first-generation participants engaged in trust-building processes that commonly prioritised community structures, whereas their younger second-generation counterparts occupied a unique position of cultural mediation—possessing high digital confidence which gained them access to worldwide information whilst also relying on traditional community trust structures. These participants’ trust verification processes reflected this duality, combining independent digital verification with community-based validation, with the latter weighing more heavily if there had been a negative online encounter (e.g. social media scam).

She [community leader] told me directly, would you like to come [to a study focus group]? I was like, yeah. Like, that meant a lot… (22, male, White and Asian).

For these populations especially, these accounts of digital-cultural mediation reveal how multi-level trust building in research is increasingly a collective rather than individual process.

For most participants, acquiring a ‘visual anchor’ of the person or team that represented the research felt important for initial and sustained engagement in a study. Some patterns of preference between how this visual anchor was created appeared complex and depended on digital ability, social position, cultural expectation, personal traits, and study factors such as level of commitment perceived by a given study to the individual.

Although participants developed impressions and connections with the organisation, study, and researchers through various means, it was the in-person, face-to-face interactions that appeared to prove most decisive influencer to participant engagement. These physical encounters ultimately either confirmed or contradicted the impressions and feelings participants had developed either before or after these meetings.

..whether it’s the person who offers to make you a cup of tea, whether it’s the young clinician who’s apologising for prodding you in places that normally wouldn’t have, you know it’s the whole atmosphere…and that seems to be enhanced obviously by resources.. the flow of information is really clear. Everything that I’ve given to them was taken with respect and the way that I’ve been treated has built up my trust in that process. (69, male, White).

In a few cases where a relationship did not seem to have been established with research staff at an individual level, participants that appeared motivated by an altruistic and/or personal value to their contribution did continue participating in the study.

These trust assemblages reveal how conventional concepts of trust in digital research is not a linear process but as a taxonomy of verification practices influenced by participants’ intersecting positions which are enacted through multiple channels.

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