A framework for digital health equity (2022)

Researchers provide a comprehensive Framework for Digital Health Equity, detailing key digital determinants of health (DDoH), to support the work of digital health tool creators in industry, health systems operations, and academia.

The rapid digitization of healthcare may widen health disparities if solutions are not developed with these determinants in mind. Their framework builds on the leading health disparities framework, incorporating a digital environment domain. The authors examine DDoHs at the individual, interpersonal, community, and societal levels, discuss the importance of a root cause, multi-level approach, and offer a pragmatic case study that applies their framework.

Discussion

The rapid digital transformation of healthcare may contribute to increased inequality. Health interventions often lead to
intervention-generated inequalities as they are typically adopted unevenly with disparity populations lagging behind. Digital health is particularly vulnerable to this as interventions are likely to disproportionately benefit more advantaged people with greater access to money, power, and knowledge. Digital health leaders and developers in industry, academia, and healthcare operations must be aware of the DDoH and the roles they play to ensure that the use of technology does not widen disparities.

The autors expand the NIMHD Research Framework to incorporate a digital environment domain detailing key DDoH. Currently, there is no comprehensive framework for digital health equity that addresses determinants at all levels and provides context with the SDoHs. Without an understanding of the DDoHs in context, digital health solution development and research may result in tools and knowledge that are incomplete as they do not address the cumulative or interactive effects of multiple domains. Notably, the framework includes both risk and resilience factors which is key as we support a strengths-based approach to development. Digital health stakeholders concerned with equity and impact should consider the DDoHs in product development and intervention design and dissemination, incorporating community and societal-level determinants as well as developing multi-level approaches. By expanding the leading health disparities research framework for digital health equity, we hope digital health leaders in the industry, academia, policy, and the community will benefit from decades of progress in the field of health disparities as well as see their work in the larger context of SDoHs so that we might work together towards meaningful progress in using digital means to achieve health equity for all.