JMIR Publications

ABSTRACT

Background:

The digital divide constitutes a growing form of social inequality, influencing access to, use of, and benefit from digital health technologies. Accurate assessment of this phenomenon requires psychometrically sound measurement instruments, especially in healthcare contexts.

Objective:

This systematic review aimed to identify and evaluate the psychometric properties of instruments developed to measure the digital divide, with a particular focus on their application in health-related settings.

Methods:

A systematic review was conducted following PRISMA 2020 and COSMIN guidelines. Literature searches were performed in PubMed, Scopus, Dialnet, and Web of Science for studies published between 2015 and 2025. The protocol was registered in PROSPERO (CRD420251068347). Inclusion criteria required studies to report psychometric evaluation of instruments measuring the digital divide.

Results:

Four studies met the inclusion criteria. All reported acceptable internal consistency (Cronbach’s α > 0.70) and employed exploratory and/or confirmatory factor analysis. However, methodological limitations were identified, including the lack of pilot testing, insufficient assessment of item comprehensibility, and absence of advanced measurement models such as Rasch analysis. Despite promising tools, the limited number of validated instruments and heterogeneity in methodology highlight the need for further cross-cultural validation and the development of standardized tools applicable in diverse populations and healthcare contexts.

Conclusions:

Existing instruments show potential for assessing digital inequality in health, but further psychometric validation and cultural adaptation are required. Nursing professionals are encouraged to lead efforts in developing and validating context-sensitive instruments to promote digital health equity.