JMIR Publications

ABSTRACT

Background:

Digital exclusion is a multi-dimensional and relational process shaped by interactions among individuals, technologies, institutions, and wider social structures. Research on digital exclusion has expanded significantly in recent years, largely due to the COVID-19 pandemic and the rapid digitalization of health, welfare, and public services. Yet, despite this growth, conceptualizations of digital exclusion remain fragmented, limiting comprehensive understanding of how digital exclusion contributes to creating or intensifying health disparities.

Objective:

To develop an understanding of how digital exclusion has been conceptualized differently across diverse bodies of literature on health inequalities.

Methods:

We conducted a hermeneutic review using keyword and snowballing searching across PubMed, Scopus and supplementary sources including citation tracking and grey literature published between January 2020 and July 2025. Analysis involved repeated reading, note-taking, and comparative interpretation of each text’s disciplinary field, theoretical orientation, and underlying assumptions about how digital exclusion is framed in relation to health inequalities. Knowledge users contributed throughout to ensure the developing interpretations remained grounded in lived and practice-based experience.

Results:

Thirty-one publications were included, spanning multiple disciplines and theoretical orientations. Five interpretive frames were identified: 1) Inequality, which conceptualizes digital exclusion as arising from unequal social, economic, and material conditions; 2) Power and Social Injustice, which highlights how institutional rules, governance arrangements, cultural norms, and service pathways condition who is recognized or supported, showing how digital systems can reproduce existing social hierarchies; 3) Life Transitions, which illustrates how exclusion shifts during periods of disruption or change, emphasizing the fluctuating conditions and vulnerabilities associated with major life changes; 4) Psycho Behavioral, which focuses on psychological, cognitive, and emotional responses to digital demands, and 5) Sociotechnical Misalignment, which frames exclusion as arising when digital systems do not align with people’s routines or everyday contexts. These interpretative frames show that digital exclusion is a dynamic, multi level, relational phenomenon influenced by interactions among structural conditions, institutional practices, life circumstances, individual experiences and system design.

Conclusions:

This hermeneutic review identifies five interpretative frames that integrate diverse disciplinary perspectives on how digital exclusion contributes to health inequalities. The frames clarify the multiple, intersecting processes through which exclusion is produced and reproduced, helping to explain its persistence and uneven impacts. Our findings highlight the need for future research that examines structural and institutional mechanisms alongside lived experience, and for digital health policy and practice to move beyond access focused solutions towards equity oriented service design, organizational practices, and evaluation.