Author : Natalie Chalmers, Edinburgh Napier University – Natalie is part of the CSO funded Health-Justice Nexus programme at 黑料正能量.’
When I began my PhD in digital health intervention development, digital health was still on the fringes of mainstream healthcare and public health. For most people, it meant fitness trackers or sleep monitors, rather than tools to support complex mental and physical health conditions. Few could have predicted how rapidly that landscape would change.
This reflection is aimed at researchers, clinicians, healthcare leaders and policy makers working with pre-COVID digital health evidence and seeking to position it meaningfully in a transformed landscape, particularly those navigating how to frame historically situated data with confidence and clarity.
In 2015, my research focused on developing a digital weight-management intervention for people with bipolar disorder. I conducted qualitative interviews to explore lived experiences, needs, and barriers, while developing logic models and frameworks to guide a systematic, theory-informed intervention. At the time, digital health interventions required justification; questions of feasibility, acceptability, and clinical relevance were central. Digital delivery was innovation, not expectation.
Then COVID-19 arrived, and digital health suddenly became indispensable. Services that had taken years to pilot were implemented at speed, not because the evidence was complete, but because remote delivery became a public health necessity. Researchers and practitioners were navigating a rapidly evolving digital focussed environment.
These changes did more than alter delivery; they reshaped how digital health was understood within healthcare systems. Approaches once seen as innovative became routine, and implementation of concepts that once needed justification became embedded in practice.
Several years on, I am now writing up my PhD findings for publication. Digital health has expanded rapidly, yet my data were collected pre-pandemic and will be read through a post-COVID lens. This raises important questions: how should pre-pandemic digital health research be understood in a post-pandemic world, and what can it still contribute?
Looking back, some findings remain robust. Participants’ experiences of managing weight alongside bipolar disorder, balancing medication, mood fluctuations, and competing priorities, continue to resonate. The need for flexible, supportive, and integrated care has not changed. Other findings feel context dependent. Pre-COVID barriers around digital access, confidence, and uncertainty may now reflect persistent issues of digital exclusion or health literacy rather than unfamiliarity. Engagement and suitability might look different today, shaped by broader exposure to digital health, new opportunities, and even digital fatigue. Priorities around weight management have also shifted, with greater public health attention on long-term physical health and risk management.
If I were writing this up today, I would frame limitations as reflections of context rather than shortcomings. Slow recruitment or cautious engagement would be presented as meaningful insights about readiness and trust. I would foreground equity, access, and sustainability, emphasising who digital interventions reach and who might be excluded. And I would no longer apologise for conducting research when digital health was still emerging, capturing barriers before widespread adoption is a strength, not a weakness.
For others writing up pre-COVID digital health research, some practical guidance may help ensure that the work retains value:
- Name the context explicitly. Situate your work clearly in the pre-pandemic landscape, when digital delivery required justification rather than assumption.
- Avoid retrofitting pandemic narratives. Let the data speak from the time in which they were generated, rather than reshaping them to align with post-COVID expectations.
- Frame findings as historically situated, not obsolete. Pre-COVID barriers, hesitations, and engagement patterns offer valuable insight into readiness, trust, and early adoption dynamics.
- Be explicit about what has changed, and what has not. Distinguish between shifts in delivery infrastructure and the enduring realities of patient need, equity, and lived experience.
- Position “before” data as strategically important. Understanding digital health prior to rapid scale-up provides a baseline for evaluating sustainability, inclusion, and long-term impact.
Pre-COVID research is not outdated; it is foundational. It captures digital health at the moment just before necessity accelerated adoption. In doing so, it offers something uniquely valuable: perspective.