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Digital health infrastructure challenges to support health equity in the United States: A scoping review

Shongkour Roy, PhD Student1, Stella Lartey, PhD1, Polina Durneva, PhD2, Michael Arthur Ofori, MPhil1, Zebunnesa Zeba, MPH1, Niharika Jha, PhD student, MPH1, Nichole Saulsberry-Scarboro, PhD1, Michelle Taylor, MD, DrPH, MPA3 and Ashish Joshi, PhD1

Affiliation

  1. University of Memphis, School of Public Health, Memphis, TN
  2. University of Memphis, Fogelman College of Business & Economics, Memphis, TN
  3. Shelby County Health Department, Memphis, TN

ABSTRACT

Background: Even though digital health is widely utilized in the United States (U.S.) at hospital providers and individual levels, it is beset with several challenges that have led to inequities in the health service delivery. Previous studies have shown that health inequities observed may be amplified many digital health requirements.

Objective: The objectives of this scoping review are to create map review-level evidence that describes digital health infrastructures focused on promoting health equity and identify key challenges regarding digital health to minimize health inequities of underserved populations.

Methods: We adapted Arksey and O'Malley's scoping review guidelines in our review. PubMed, Web of Science, CINAHL, and PsycINFO were searched. We also conducted supplementary searches in Google Scholar and Grey Literature. The inclusion criteria were peer-reviewed publications that broadly conceptualize or analyze digital health infrastructure from a health equity perspective and the challenges of digital health requirements between 2020 and 2024. Following a full-text screening using eligibility criteria, two researchers evaluated each citation’s individually at the title and abstract levels. Thematic approach qualitative analysis determined this scoping review’s outcome.

Results: Of the 438 research articles from the search, 34 (7.7%) were included in the analysis based on the inclusion criteria. In this review, we discuss providers and individual challenges that exist in health equity related to digital health. The most common challenges for providers were infrastructure and technical issues, while for individuals, this included data privacy, information sharing, and access to digital tools.

Conclusion: The study identified that in the U.S., digital health is an essential part of the delivery of health services, yet it is saddled with key challenges leading to health inequities. Finding pragmatic solutions to these challenges can improve health equity in digital health.