Currently submitted to: Journal of Medical Internet Research
Date Submitted: Mar 31, 2026
Open Peer Review Period: Apr 22, 2026 - Jun 17, 2026
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Mapping the Social and Digital Determinants of Access to and Use of Digital Health Tools in Germany and France: A Scoping Review
ABSTRACT
Background:
As the digital transformation of healthcare systems accelerates, interest in the Social and Digital Determinants of digital health tools is growing. This OSF-registered scoping review maps how these determinants are assessed in both countries and identifies research implications.
Methods:
Using the PiCo framework, PubMed, Scopus, and Web of Science were searched for peer-reviewed primary studies (2015-2025; English, German, French) on access and use of digital health tools in Germany or France. Eligible studies were screened and extracted using a standardized template in the Covidence software. Descriptive and exploratory analyses were conducted in SPSS. Exploratory correlation-based heatmaps were used to visualize recurring determinants, barriers, and facilitators shaping digital health access and use.
Results:
Seventy studies, 59 from Germany and 11 from France, were included, most were quantitative and cross-sectional. Frequently reported social determinants of health consisted of age, gender, education, geographic location, and health literacy, while central digital determinants of health included digital literacy, trust in digital tools, perceived usefulness, usability, and access to digital infrastructure. Comparative analyses revealed both shared patterns and country-specific emphases, with German studies more frequently addressing eHealth literacy and functional aspects of digital health, while French studies placed greater emphasis on social environment, housing conditions, and ethical considerations.
Conclusions:
Whether social or digital, most determinants were either person- or technology-centered. While reflecting an emerging field focused on individual-level factors, this emphasis risks overlooking broader, multi-level, mechanisms of social inequalities that may also shape digital health access and use. Trial Registration: not applicable.
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