Abstract
ObjectiveGlobally, the number of digital health solutions is increasing, but they are not always designed with access and utilisation for people with impairments in mind. Development efforts have often not included the voice and requirements of people with impairments, who make up 15% of the world’s population, despite the fact that this can help ensure broad access and utilisation. Little attention to and limited inclusion of people with impairments in the development of digital health solutions results in continued and reinforced inequalities in health services provision for people with impairments. This review investigates the needs and barriers of people with impairments related to use of digital health solutions and strategies to foster user participation, access and utilisation of digital health solutions.MethodsThis scoping review, based on the Joanna Briggs Institute Manual, had five phases: 1) identification of aim and research questions, 2) literature search in five databases (April/May 2020), 3) literature screening based on predetermined inclusion and exclusion criteria, 4) data extraction, and (5) reporting results.ResultsThe literature search resulted in 5968 sources, of which 25 met our inclusion criteria. People with impairments appreciate digital health solutions that are designed to meet their specific impairment-related challenges. The reported needs and barriers related to technological design varied depending on the individuals’ challenges. The literature reported different types of participatory co-design strategies to foster access and utilisation of digital health solutions.ConclusionThis scoping review support needs for increased awareness among developers to design solutions that meet people’s needs, contexts and states of health. By applying universal design as a strategy and including people with different types of impairments, starting in the idea creation phase of digital health solutions and throughout the development, developers can design solutions with better accessibility. Digital health solutions that are accessible and usable have a tremendous opportunity to foster health equity and achieve health promotion, prevention and self-care. This in turn can contribute to closing the gap between different population groups, reduce disparities and get the most from available healthcare services.
Highlights
A plethora of digital health solutions has been suggested, designed and/or deployed
This review indicates that a low degree of user participation of people with impairments early in the development of digital health solutions may introduce additional barriers and exclusion, as people with impairments do not fully benefit from the deployed solutions
According to the internationally accepted convention CRPD [18], digital health solutions must be accessible and usable for all, including people with impairments and other underserved groups. This scoping review indicates that the use of universal design principles and actively engaging with people having different types of permanent or transient impairments, starting in the idea creation phase of digital health solutions, is more likely to result in solutions that are accessible to everyone regardless of their state of health
Summary
A plethora of digital health solutions has been suggested, designed and/or deployed. During COVID19, many countries adopted social distancing measures, and the availability of and access to digital health solutions for all are highly pertinent to ensure good public health. Digital health is a broad term that includes the use of information and communication technology, such as software applications, mobile phones and wearable devices, to support peoples’ health and their quality of life. The World Health Organization (WHO) emphasises that digital health is essential in achieving universal health coverage as “it extends the scope, transparency and accessibility of health services and health information, widening the population base capable of accessing the available health services and offering innovation and efficiency gains in the provision of health care” [1]. In this paper we focus on digital health solutions and services intended for personal use. Examples are apps and devices for self-management and monitoring of health conditions and contact with health professionals
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