Frameworks for implementation, uptake and use of digital health interventions in ethnic minority populations: a scoping review using cardiometabolic disease as a case study. (Preprint)

BACKGROUND Digital health interventions (DHIs) have become increasingly common across healthcare, both before and during the COVID-19 pandemic. Health inequalities, particularly by ethnicity, are recognised across diseases, but may be excluded in frameworks addressing implementation of DHIs. OBJECTIVE Using cardiometabolic disease as an exemplar, this scoping review aims to assess how health inequalities are addressed in frameworks relevant to the implementation, uptake and use of DHIs, health and ethnic inequalities, and interventions for cardiometabolic disease. METHODS SCOPUS, PubMed, EMBASE and grey literature was searched to identify frameworks relevant to: implementation, uptake and use of DHIs; ethnically or culturally diverse populations and health inequalities; and interventions for cardiometabolic disease. We assessed the extent to which these include health inequalities, specifically regarding ethnicity; and explored how these were addressed, drawing out recommendations for good practice. RESULTS Of 58 relevant frameworks, 22 (38%) included reference to health inequalities. Inequalities were conceptualised to operate across four levels: society, system, intervention and individual. Only five frameworks considered all levels. Three frameworks considered how DHIs might interact with or exacerbate existing health inequalities; and three considered the process of implementation, uptake and use of health technologies and suggested opportunities to improve equity in digital health. Where ethnicity was considered, this was often within the broader social determinants of health. Only three frameworks explicitly addressed ethnicity: one focused on culturally tailoring DHIs; and two were applied to management of cardiometabolic disease. CONCLUSIONS Existing frameworks evaluate implementation, uptake and use of DHIs, but to consider factors related to ethnicity necessitates looking across frameworks. We have developed a guide to support future research to assess real world usability and applicability of these frameworks, to mitigate against digital health inequalities and to inform digital health policies.