Digital health interventions as a catalyst for change: A narrative review of the roles of digital health in enhancing well-being and reducing public health and social issues among sex workers.

Background: Digital health interventions (DHIs) are increasingly recognized for their potential to address public health and social issues. Among sex workers, these interventions have demonstrated promise in areas such as mental health support, harm reduction, and access to healthcare services. Importantly, the social and structural barriers faced by sex workers, including criminalization, stigma, and marginalization, are deeply intertwined with poor health outcomes, and DHIs may offer a means to tackle both simultaneously. However, existing literature often lacks a comprehensive understanding of their broader roles in enhancing overall well-being and addressing systemic challenges faced by this population, such as limited access to digital tools, inadequate integration of DHIs in sex work health services, and the absence of tailored digital strategies for marginalized groups. This review seeks to bridge this gap by examining the diverse applications and impacts of DHIs on the well-being of sex workers and their ability to mitigate public health and social issues. Objective: To review the roles of DHIs in enhancing well-being and reducing public health and social challenges among sex workers, while identifying key opportunities and barriers. Methods: A narrative review methodology was employed. Relevant peer-reviewed articles and gray literature published between 2010 and 2023 were identified through systematic searches of databases including PubMed, Scopus, Science Direct, CINAHL, Web of Science, and PsycINFO. The search used keywords such as "digital health," "sex workers," "public health," "social well-being," and "interventions." Studies were included based on relevance, methodological rigor, and focus on sex workers. Inclusion criteria comprised studies that specifically addressed DHIs targeting sex workers, were published in English, and provided empirical findings or substantial discussions on well-being or public health outcomes. Exclusion criteria included articles that focused solely on general digital health tools without reference to sex workers, opinion pieces without empirical support, and studies outside the stated time frame. Data were charted and thematically analyzed to map trends, opportunities, and gaps. Results: Findings indicated that DHIs play a significant role in reducing systemic barriers that perpetuate poor health outcomes among sex workers. For example, mobile-based mental health platforms provided confidential support that helped overcome stigma and fear of discrimination in traditional healthcare settings. Digital harm reduction tools, such as online peer-education networks, were effective in reducing unsafe practices by addressing the marginalization that often prevents sex workers from accessing mainstream services. Furthermore, DHIs tailored to regions where sex work is criminalized enabled discreet access to sexual and reproductive health services, demonstrating how technology can mitigate the health risks tied to structural inequities. Nonetheless, gaps persist due to limited digital literacy, inadequate infrastructural support, and the absence of sex worker-centered policy frameworks. Conclusion: DHIs are a catalyst for change, addressing critical health and social disparities among sex workers. Recognizing the co-constitution of public health and social challenges enables a more integrated approach to intervention design and policy development. However, to maximize their impact, future efforts should focus on overcoming barriers, fostering inclusivity, and ensuring sustainability. Specific actions should include investing in digital infrastructure tailored to the needs of sex workers, co-developing interventions with community input, training healthcare providers on digital tools and sex worker-specific issues, and creating policies that protect digital privacy and reduce stigma. Policymakers and stakeholders must collaborate to integrate these interventions into broader public health frameworks.