Abstract
BackgroundElectronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities.ObjectiveThis systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups.MethodsA systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis.ResultsA total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions.ConclusionsThe findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity.
Highlights
BackgroundElectronic health, “the use of information and communications technology (ICT) in support of health and health-related fields” [1], is increasingly being integrated into the delivery of health resources and services
The purpose of this review was to answer the following research questions: 1. Was eHealth literacy considered during the development of eHealth interventions targeted at socially disadvantaged groups? If yes, what approaches were used to determine the eHealth literacy needs of the target group?
Were eHealth interventions targeted at socially disadvantaged groups effective when eHealth literacy was considered?
Summary
BackgroundElectronic health (eHealth), “the use of information and communications technology (ICT) in support of health and health-related fields” [1], is increasingly being integrated into the delivery of health resources and services. Less education, lower income, being from an ethnic minority group, or living in a remote area are all associated with decreased access or less use of the internet for activities such as health information seeking, communicating with health care providers, monitoring health, or using personal health records [11,12,13,14,15] As such, these socially disadvantaged groups are usually overlooked in eHealth design [15] and are at risk of becoming digitally marginalized [7,16], leading to a potential widening of health disparities. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide This will assist the realization of recent technological advancements and, importantly, improve health equity
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