Digital Health Technology Infrastructure Challenges to Support Health Equity in the United States: Scoping Review.

Background: Although digital health technology (DHT) is widely used in the United States at both hospital provider and individual levels, it is beset with several challenges that have contributed to inequities in the health service delivery. Previous studies have shown that health inequities observed may be amplified many times by DHT requirements. Objective: The objectives of this scoping review are aimed at synthesizing information on DHT inequities by exploring evidence that describes DHT infrastructure needs focused on promoting health equity in the United States and identifying key challenges both at the individual or patient level and at the health service provider's level. 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 on Google Scholar. The inclusion criteria were peer-reviewed publications that broadly conceptualize or analyze DHT infrastructure from a health equity perspective and the challenges of DHT requirements between 2020 and 2024. We have screened the full text of articles using eligibility criteria such as studies that were included if they examined DHT infrastructure in the United States from a health equity perspective, discussed health disparities resulting from DHT interventions, or investigated the variables influencing health inequities connected to DHT. Two researchers (SR and ZZ) evaluated each citation individually at the title and abstract levels. The thematic approach and qualitative analysis determined this scoping review's outcome. Results: Of the 628 research papers from the search, 27 were included in the analysis based on the inclusion criteria. In this review, we discussed factors such as older adult population, education, race, ethnicity, and socioeconomic status leading to health inequities in DHT. Patients and service providers face challenges related to health inequities in the use of DHT. The most common challenges for service providers were infrastructure and technical issues such as inadequate integration with existing workflows, user-unfriendly health information exchange interfaces, and lack of skilled staff, while for individuals or patients, this included limited broadband web-based access, cultural or linguistic appropriateness, and access to digital tools. Conclusions: The study identified that in the United States, DHT 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 DHT.