BACKGROUND: Digital health interventions can support health-related knowledge transfer, for example through websites or mobile applications, and may reduce health inequalities by making health care available, where access is difficult, and by translating content to overcome language barriers. However, digital health intervention can also increase health inequalities due to the digital divide. To reach digitally excluded populations, design and delivery mechanisms need to specifically address this issue. This review was conducted during the evolving COVID-19 pandemic and informed the rapid design, deployment and evaluation of a post-COVID-19 rehabilitation digital health intervention: 'Living with COVID Recovery' (LWCR). LWCR needed to be engaging and usable for patients and to avoid exacerbating health inequalities. LWCR was introduced as a service into 33 NHS clinics, was used by 7679 patients, and evaluation ran from August 2020 to December 2022.
OBJECTIVE: To identify evidence-based digital health intervention design and deployment features conducive to mitigating the digital divide.
METHODS: Cochrane Library, Epistemonikos, National Institute for Health and Care Excellence Evidence, PROSPERO, PubMed (with MEDLINE and Europe PMC) and Turning Research into Practice; OpenGrey and Google Scholar were searched for primary research studies published in English from 1 October 2011 to 1 October 2021. Adults who were likely to be affected by the digital divide, including older age, minority ethnic groups, lower income/education level and in any healthcare setting.
INTERVENTIONS: Any digital health intervention with features of design and/or deployment intended to enable access and engagement by the population of focus.
COMPARATORS: Any or none.
OUTCOME MEASURES: Any related to participants' access and/or use of digital health intervention and/or change in digital skills and confidence.
ANALYSIS: Data from studies that met the inclusion criteria were extracted, narratively synthesised and thematically analysed.
RESULTS: Twenty-two papers met the inclusion criteria. Digital health interventions evaluated included telehealth, text message interventions, virtual assistants, self-management programmes and decision aids. Co-development with end-users, user testing through iterative design cycles, digital health interventions that also helped improve digital skills and digital health literacy, tailoring for low literacy through animations, pictures, videos and writing for low reading ages; virtual assistants to collect information from patients and guide the use of a digital health intervention.
DEPLOYMENT THEMES INCLUDED: Free devices and data, or signposting to sources of cheap/free devices and Wi-Fi, text message interventions, providing 'human support', providing tailored digital skills education as part of the intervention and enabling peer/family support.
LIMITATIONS: Our search extended to late 2021, and there has been a massive increase in the literature following the pandemic. However, as our review was undertaken to inform the LWCR digital health intervention design and deployment, we have reported the results that informed this work. The studies included in the review were heterogeneous, so generalisability may be limited. Few randomised controlled trials assessed the digital health intervention's impact on digital health skills by using validated measures.
CONCLUSIONS: Using the design and deployment findings described above when developing digital health interventions may help overcome the digital divide. Beyond informing the LWCR digital health intervention development, the review findings have wider implications for the equitable design, delivery and evaluation of digital health interventions.
FUNDING: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132243.
