App-Based Digital Health Equity Determinants According to Ecological Models: Scoping Review

Abstract

Technological advances have increased the availability of diverse digital health services. However, digital health benefits are not equally accessible. Recent studies have focused on digital health equity. Researchers are progressively identifying digital determinants of health (DDoH) to address potential health disparities stemming from digital health. This study investigated the determinants of disparities in app-based digital health within the framework of an ecological model. The method proposed by Arksey and O’Malley was adopted in this review. The PubMed, Embase, Scopus, and Google Scholar databases were searched from January 2016 to December 2021. Two reviewers independently screened and selected topics according to the guidelines for the scope of the topic. A consensus was reached to reconcile the differences, and the findings were collated, synthesized, summarized, and reported. This study identified 21 studies pertaining to health equity in app-based digital health. Seven countries were included in this study. Health inequities caused by the adoption of app-based digital health can be reflected in the following three levels according to the ecological model. At the individual level (N = 20), it was influenced by sociodemographic characteristics and digital literacy factors. At the interpersonal level (N = 10), factors such as feedback mechanisms, monitoring, communication modalities, technology-sharing practices, and standardized design were observed. At the community or social level (N = 7), disparities were noted in residential locality, integrated network infrastructure, and Internet accessibility. Finally, digital health policies should consider determinants of digital health inequalities. Ensuring health equity in digital health requires the equitable implementation and measurement of health outcomes through an equity lens. Based on the findings of this study, it is essential to maintain a continued focus on digital health to prevent the further widening of health disparities.