JMIR Publications

ABSTRACT

Background:

Digital health technologies (DHTs) are increasingly promoted as tools to reduce health disparities. However, the extent to which equity-centered design methods have been applied to address the needs of Black communities remain unclear. Traditional human-centered design (HCD) approaches are often employed but may inadequately capture sociocultural and structural inequities, whereas emerging paradigms such as Black-centered design (BCD) and Afrofuturism offer alternative perspectives yet remain underutilized.

Objective:

This scoping review aimed to examine (1) the current state of research on digital health technologies designed to address equity concerns among Black communities, (2) the design approaches used in evaluating outputs for these populations, and (3) the potential of the digital determinants of health (DDoH) framework to inform the evaluation of digital health equity outcomes.

Methods:

In November 2024, we searched PubMed, Scopus, ACM Digital Library, and Google Scholar for studies at the intersection of digital health, design methodology, and health equity. Search terms combined digital health (e.g., m-health, mobile applications, wearables), equity (e.g., health equity, health disparity), and design approaches (e.g., human-centered design, participatory design, design thinking, Afrofuturism, Black-centered design). No restrictions were placed on publication date, study type, or location. Nineteen studies met the inclusion criteria.

Results:

Publications have increased over the past five years, with most studies conducted in the United States focused on women’s health, as well as HIV prevention. Black men were underrepresented, and LGBTQ+ perspectives were rarely included. HCD and community-based participatory design approaches were common, although the reporting of reflexive practices and power dynamics was inconsistent. Afrofuturist methods, although limited in number, address broader dimensions of racial well-being, such as systemic racism and social safety. Few studies have explicitly evaluated digital health equity outcomes; assessments have typically been limited to usability or feasibility. The application of the DDoH framework highlighted neglected determinants such as digital literacy, shared device privacy, and algorithmic bias.

Conclusions:

This review underscores the need for deliberate integration of equity frameworks in digital health design for Black communities. Clearer, measurable equity criteria that go beyond usability testing are essential to ensure that interventions are inclusive and accessible for marginalized communities. Hybrid approaches that combine the pragmatism of HCD with the liberatory vision of BCD and Afrofuturism hold promise for shaping more equitable digital health futures.