Promoting equity in App based Digital Health

Abstract

Digital health innovations have been rapidly implemented and scaled to solve health challenges posed by the coronavirus disease (COVID-19) pandemic. Digital health technologies can potentially improve healthcare access, utilization, and experience for people; at the same time, their development and use can reinforce, exacerbate, and even create health disparities. Applying a health equity lens to digital health innovations can help inform the equitable design and development of digital health tools. This study attempted to identify the digital determinants of health through empirical research based on the recently emerging theoretical framework and ecological model of digital health equity and sought a direction for improving digital health equity by synthesizing the main results. To confirm this, the Scoping Review was conducted. PubMed, Embase, Scopus, Web of Science, and Google Scholar were searched. A total of 434 studies were retrieved from 2016 to 2020, and a final 21 articles (4.8%) were identified by applying duplicate and exclusion criteria. The results are as follows. There is digital literacy, efficacy, and confidence at the individual level. At the interpersonal level, it is digital interdependence, and communication, balanced between the patient-tech-clinician relationship, the developer's pursuit of health equity value and understanding of health impact, and joint participation in app development. At the community level, these are community infrastructure, Internet broadband communication, integrated network infrastructure, health care infrastructure, and availability of digital resources. At the societal level, it is strengthening the governance of digital health. This study presents the Digital Health Equity Framework, which can be used to consider health equity factors. Digital determinants of health that can cause digital health inequality due to the adoption of app-based digital health technology were examined in multiple dimensions, such as individuals, interpersonal relationships, communities, and societal levels. In addition, policy directions were suggested to improve the equity of digital health. (e.g., Co-design of apps for access to digital health). In the future, it is necessary to develop a measurement-based approach to digital health equity and use these results to validate further and refine this model.