JMIR Publications

ABSTRACT

Background:

The use of patient-facing digital technologies within healthcare rapidly increased as services transferred to online platforms during the COVID-19 pandemic. Inequalities in digital health across the domains of equity are not routinely examined, yet the longer-term integration of digitally delivered services needs to take into account such inequalities to ensure equitable benefit.

Objective:

The aim of this scoping review was to map inequities in access, use and engagement with digital health technologies, across equity domains.

Methods:

We searched 4 electronic databases (MEDLINE, ASSIA, PsycINFO, Scopus) for published quantitative and mixed methods reviews and meta-analyses published between Jan 2016-May 2022. Reviews were limited to those that included studies from the World Health Organization’s European region. Extracted data was mapped against Cochrane’s PROGRESS PLUS dimensions of equity.

Results:

Four hundred and four unique citations were identified from the searches and two citations from other sources. After eligibility assessment, 22 reviews were included. Consistent evidence was found showing higher access to digital health technologies among patients who were of white ethnicity, English- speaking and with no disability. There were no reviews that explored differences in access to digital healthcare by age, gender/sex, occupation, education, or homeless/substance misuse. Higher use of digital health technologies was observed amongst populations which were white, English-speaking, younger in age, with higher level of education, of higher economic status and resident in urban areas. No clear evidence of differences in use of digital technologies by occupation, gender/sex, disability, or homeless/substance misuse was found. Nor was clear evidence found in the included reviews on inequalities in the engagement with digital technologies. Finally, no reviews were identified that explored differences by place of residence.

Conclusions:

Despite awareness of the potential impact of inequalities in digital health, there are important evidence gaps across multiple equity domains. The development of a common framework for evaluating digital health equity in new health initiatives, and consistency in reporting findings is needed.