JMIR Publications

ABSTRACT

Background:

Healthcare systems have become increasingly more reliant on a patient’s ability to navigate the digital world. However, little research has been conducted into why some communities are less able, or less likely, to successfully engage with digital health technologies (DHTs), particularly among culturally and linguistically diverse (CaLD) populations.

Objective:

This qualitative systematic review aims to determine the barriers and facilitators to interacting with DHTs from the perspectives of CaLD population groups, including Indigenous/First Nations people.

Methods:

A systematic review and thematic synthesis of qualitative studies was conducted. Peer-reviewed literature published from January 2011 to June 2022 was searched for across three electronic databases. Terms for digital health were combined with terms for cultural and/or linguistic diversity, ethnic minorities or Indigenous/First Nations people, and terms related to barriers to accessing digital technologies. A qualitative thematic synthesis was conducted to identify descriptive and analytical themes of barriers and facilitators to interacting with DHTs. Quality appraisal was undertaken using the Mixed Methods Appraisal Tool.

Results:

Of the 1,418 studies identified in the electronic search, a total of 34 studies were included in this review. Half the included studies were conducted in the USA. There was considerable variation in terms of CaLD backgrounds of participants. Nine studies focused on Indigenous communities, 14 were conducted among ethnic minority populations, five studies were conducted among immigrants, and six in refugee communities. Twenty-one studies described development or evaluation of a digital health intervention, while 13 studies did not include an intervention but instead focussed on elucidating participants’ views and behaviours in relation to digital health. From the 34 papers analysed, seven overarching analytical themes were identified as either barriers or facilitators to use of DHTs: 1) Using Technology; 2) Design Components; 3) Language; 4) Culture; 5) Health and Medical; 6) Trustworthiness; and 7) Interaction with Others.

Conclusions:

This study identified several analytic and descriptive themes influencing access to and uptake of digital health technologies among CaLD populations, including Indigenous groups. We found that cultural factors impacted upon all identified themes to some degree, and that cultural and linguistic perspectives should be considered in the design and delivery of DHTs, with this best served through inclusion of the target communities at all stages of development. This may improve the potential of DHTs to be more acceptable, appropriate, and accessible to population groups currently at risk of not obtaining the full benefits of digital health. Clinical Trial: Nil