Exploring public health equity in digital access: voices from marginalized groups using the "Mawid" application in Saudi Arabia.

Background: Digitalization of healthcare services can significantly enhance the services and access to quality care. However, the equity implications of access to healthcare by such digital health platforms for marginalized populations remain underexplored, especially in the countries which are rapidly transforming their healthcare system through digitalization, such as Saudi Arabia. In this context, this study aims to investigate digital inclusion and health equity among users of the Saudi Ministry of Health's "Mawid" application. Methods: A qualitative exploratory design was adopted in this study using five focus groups discussions (25 participants with five participants in each group) as an approach for data collection. Each focus group is categorically included participants of older adults, rural residents, low-income individuals, people with disabilities, and intersectional users who combined these characteristics respectively. Braun and Clarke's thematic analysis framework was used to identify key patterns and themes from the data collected through discussions. Results: Findings revealed that Mawid often functioned as a conditional gatekeeper to healthcare, with barriers related to digital literacy, infrastructural constraints, time poverty, and accessibility. Participants relied heavily on informal support networks, frequently at the cost of privacy and autonomy. Uniform system design was perceived to disadvantage users with complex social and health needs. Conclusion: Government-managed digital health applications enhances efficiency of healthcare operations, but may reinforce health inequities, if equity-centred digital design and alternative access pathways are not considered in the system design and formulation of digital health strategies.