JMIR Publications

ABSTRACT

Background:

Health disparities persist and are influenced by digital transformation. Although digital tools offer opportunities, they can also exacerbate existing inequalities, a problem amplified by the COVID-19 pandemic and the related infodemic. Health Equity Audit (HEA) tools, such as those developed in the United Kingdom, provide a framework to assess equity but require adaptation for the digital context. Digital Determinants of Health (DDoH) are increasingly recognized as crucial factors influencing health outcomes in the digital era.

Objective:

This editorial proposes an approach to extend HEA principles to create a specific framework, named Digital Health Equity Audit (DHEA), designed to systematically assess and address health inequities within the design, implementation, and evaluation of digital health technologies, with a focus on DDoH.

Methods:

A cyclical DHEA model based on existing HEA principles is proposed, integrating them with digital health equity frameworks. The DHEA cycle comprises six phases: 1) Scoping the audit and mobilizing the team (including community members); 2) Developing the digital health equity profile and identifying inequities (assessing DDoH at individual, interpersonal, community, and societal levels); 3) Identifying high-impact actions to address DDoH and inequities; 4) Prioritizing actions for maximum equity impact; 5) Implementing and supporting change; 6) Evaluating progress, impact, and refining. The method emphasizes multi-level interventions and stakeholder engagement.

Results:

The main result is the articulation of the DHEA framework itself: a structured, 6-phase cyclical model to guide organizations in the analysis and proactive mitigation of digital health-related disparities. The framework explicitly integrates the assessment of Digital Determinants of Health (DDoH) across multiple levels (individual, interpersonal, community, societal) and promotes the development of targeted interventions to ensure digital solutions promote equity.

Conclusions:

The DHEA model offers an integrated approach to consider social, epidemiological, health, and technological variables, aiming to reduce health inequities through the conscious use of new technologies. It is emphasized that digital technologies can be the cause or the solution to inequalities; DHEA is proposed as a tool to foster equity. Its systematic adoption, along with a collaborative approach (co-design) and trust-building, can help ensure the benefits of health digitalization are equitably distributed, while strengthening trust in institutions. Continued attention is needed to manage emerging challenges such as infodemiology in the era of Big Data and AI. Clinical Trial: NN