Strategies to develop, design, implement and support digital health equity in key underserved groups: protocol for a systematic review

Abstract

AbstractBackgroundDigital health technologies (DHT) can be used to detect and remotely monitor digital biomarkers associated with prodromal dementia. However, there are growing concerns that DHT are not leading to demonstrable health benefits in all populations, particularly the underserved who are typically neglected in research resulting in worse health outcomes. One possible cause is digital exclusion, which refers to the unfair differences in access, use, motivation and reliability in DHT across different demographic groups. The UK regulatory bodies acknowledge the need to mitigate digital exclusion, leading to the development of inclusive digital strategies such as tailoring DHT to ensure it is appropriate to individuals in terms of affordability, culturally applicable, and accessible. This systematic review will synthesize the literature regarding strategies to improve digital inclusivity for underserved groups at risk of digital exclusion.MethodThis review will follow PRISMA guidelines and involve systematically searching four large databases (Medline, Embase, PsycINFO, Scopus). It has been registered on PROSPERO: CRD42022378199. Search terms will be used to identify relevant studies focusing on factors associated with digital exclusion, including: Culture (ethnicity, language, religion), Limiting conditions (visual and hearing impairments), Education, Age, Residence (rural or deprived areas, homelessness), and Socioeconomic status (low to middle‐income and unemployed individuals), summarised by the acronym CLEARS (Figure 1). Primary research English‐language studies using qualitative or mixed methods to explore facilitators and barriers to digital inclusion will be included. Studies will be independently screened by two additional reviewers using a computer software, Rayyan. The methodological quality of studies will be assessed using a checklist designed to assess qualitative and mixed methods. A narrative synthesis of data from included studies will be conducted.ResultThis review will integrate the evidence available on the facilitators and barriers associated with the design and implementation of digitally inclusive strategies for DHT in CLEARS groups. Key recommendations for digitally inclusive strategies to support health equity will also be produced.ConclusionThe results of this review will be used to support digital health equity in research by providing recommendations for the development, design, and implementation of strategies to promote digital health equity in key underserved groups.