Digital Health Equity: Addressing Power, Usability, and Trust to Strengthen Health Systems

Abstract

Background: Without specific attention to health equity considerations in design, implementation, and evaluation, the rapid expansion of digital health approaches threatens to exacerbate rather than ameliorate existing health disparities. Methods: We explored known factors that increase digital health inequity to contextualize the need for equity-centered informatics. This work used a narrative review method to summarize issues about inequities in digital health and to discuss future directions for researchers and clinicians. We searched literature using a combination of relevant keywords (e.g., “digital health”, “health equity”, etc.) using PubMed and Google Scholar. Results: We have highlighted strategies for addressing medical marginalization in informatics according to vectors of power such as race and ethnicity, gender identity and modality, sexuality, disability, housing status, citizenship status, and criminalization status. Conclusions: We have emphasized collaboration with user and patient groups to define priorities, ensure accessibility and localization, and consider risks in development and utilization of digital health tools. Additionally, we encourage consideration of potential pitfalls in adopting these diversity, equity, and inclusion (DEI)-related strategies.

RETRACTED: Malaysian Hospitals on the Web: a Multi-Criteria Assessment of Official Websites

“…Therefore, they should aim to provide information on scienti c studies, medical glossary terms or library information. The provision of properly developed content on hospital websites is an easy and accessible manner to support civic health education and promote equity (Koehle et al, 2022).…”

Telemedicine, e-Health, and Digital Health Equity: A Scoping Review

“…According to the digital e-environments or e-platforms considered, even if all the papers refer to Telemedicine and/or e-Health, some other fields are considered, like Telehealth [ 13 , 14 , 17 , 22 , 24 , 25 , 34 , 36 , 42 ] and mobile health [ 14 , 21 , 26 , 37 ]. Some authors have focused their attention on health data and described the role of electronic health records [ 28 , 31 , 43 ], electronic medical records [ 28 ], personal health records [ 43 ], and patient-generated health data [ 43 ] in promoting DHE.…”

“…Regarding the description of group/s of people at higher risk of inequalities, while the World Health Organization’ documents make a general reference to the concept of disadvantage, there is a common reference to a set of people or groups that could incur in forms of marginalization and could meet some barriers in the development of their health potential [ 5 - 7 ]. Those people are sometimes described in a general way as “groups of people with reduced resources” [ 23 , 30 , 36 , 42 ], or as “marginalized group/s or individuals” [ 15 , 21 , 22 , 28 , 38 , 46 ]. Some papers have described in a deeper way the group/s of people that could incur some forms of inequity (people with disability, people living in lower socio-economic areas, cultural ethnical, and economically diverse communities, elderly people, and people who live in rural areas) [ 27 , 40 ].…”

“…Other kinds of barriers are described from the perspective of the users, like the one related to the need to have private space in the home (or in other facilities) with the aim to guarantee privacy and confidentiality during Telemedicine consultations [ 44 ]. Other authors have focused on the role of trust and confidence of users [ 28 , 41 ] and lack of interest and motivation [ 34 ] in the effective use of instruments and tools of Telemedicine.…”

Centering Digital Health Equity During Technology Innovation: Protocol for a Comprehensive Scoping Review of Evidence-Based Tools and Approaches

“…While DHT adoption has increased gradually over the last decade, the COVID-19 pandemic accelerated its integration worldwide across health care, research, government, and industry [ 3 ]. However, this digital shift poses a risk to priority communities who may miss out on the technologies and their benefits [ 4 ]. Priority communities refer to those who require intentional support due to a history of oppressive policy choices and marginalization.…”