Social health inequalities and eHealth: A literature with qualitative synthesis of theoretical and empirical studies.


Latulippe K, Hamel C, Giroux D. (2017). Social health inequalities and eHealth: A literature review with qualitative synthesis of theoretical and empirical studies. Journal of Medical Internet Research. 19(4): e136. doi: 10.2196/jmir.6731

Researchers analyzed 73 articles that address social health inequalities (SHI) in digital health. SHI often manifests through the “digital divide” or differences between people who can access technologies necessary to use digital health approaches and those who cannot access these technologies. Beyond issues of access, researchers found that use of digital health approaches also requires sufficient knowledge to use technology and an ability and tendency to seek information that could lead one to digital health approaches. In addition, digital health approaches need to incorporate health information that is relevant and comprehensible by target audiences, particularly for populations who experience SHI. Researchers found that individuals who do not use the internet are often older and with lower incomes. For example, the cognitive and psychomotor impairments that come with old age can impact this population’s ability to use digital health approaches. Articles reviewed demonstrated that ethnicity, low income, low levels of education, and age can bring about unforeseen negative consequences of otherwise effective designs in digital health. Accessibility of digital health approaches can be improved through increased availability of public devices and internet access, making components available for offline use (e.g. downloading or printing), improved compatibility of programs with mobile devices, use of multimedia to display information (e.g. text, audio, images, videos), creation of culturally appropriate approaches, and involvement of people at risk for SHI in the digital health program development process.