Background Digital health interventions have become increasingly common across health care, both before and during the COVID-19 pandemic. Health inequalities, particularly with respect to ethnicity, may not be considered in frameworks that address the implementation of digital health interventions. We considered frameworks to include any models, theories, or taxonomies that describe or predict implementation, uptake, and use of digital health interventions. Objective We aimed to assess how health inequalities are addressed in frameworks relevant to the implementation, uptake, and use of digital health interventions; health and ethnic inequalities; and interventions for cardiometabolic disease. Methods SCOPUS, PubMed, EMBASE, Google Scholar, and gray literature were searched to identify papers on frameworks relevant to the implementation, uptake, and use of digital health interventions; ethnically or culturally diverse populations and health inequalities; and interventions for cardiometabolic disease. We assessed the extent to which frameworks address health inequalities, specifically ethnic inequalities; explored how they were addressed; and developed recommendations for good practice. Results Of 58 relevant papers, 22 (38%) included frameworks that referred to health inequalities. Inequalities were conceptualized as society-level, system-level, intervention-level, and individual. Only 5 frameworks considered all levels. Three frameworks considered how digital health interventions might interact with or exacerbate existing health inequalities, and 3 considered the process of health technology implementation, uptake, and use and suggested opportunities to improve equity in digital health. When ethnicity was considered, it was often within the broader concepts of social determinants of health. Only 3 frameworks explicitly addressed ethnicity: one focused on culturally tailoring digital health interventions, and 2 were applied to management of cardiometabolic disease. Conclusions Existing frameworks evaluate implementation, uptake, and use of digital health interventions, but to consider factors related to ethnicity, it is necessary to look across frameworks. We have developed a visual guide of the key constructs across the 4 potential levels of action for digital health inequalities, which can be used to support future research and inform digital health policies.

Background Digital health interventions (DHIs) for the prevention and management of cardiometabolic diseases have become increasingly common. However, there is limited evidence for the suitability of these approaches in minority ethnic populations, who are at an increased risk of these diseases. Objective This study aimed to investigate the use of DHIs for cardiovascular disease and type 2 diabetes among minority ethnic populations in countries with a majority of White, English-speaking populations, focusing on people who identified as South Asian, Black, or African American. Methods A realist methodology framework was followed. A literature search was conducted to develop context-mechanism-outcome configurations, including the contexts in which DHIs work for the target minority ethnic groups, mechanisms that these contexts trigger, and resulting health outcomes. After systematic searches, a qualitative analysis of the included studies was conducted using deductive and inductive coding. Results A total of 15 studies on the uptake of DHIs for cardiovascular disease or diabetes were identified, of which 13 (87%) focused on people with an African-American background. The review found evidence supporting the use of DHIs in minority ethnic populations when specific factors are considered in implementation and design, including patients’ beliefs, health needs, education and literacy levels, material circumstances, culture, social networks, and wider community and the supporting health care systems. Conclusions Our context-mechanism-outcome configurations provide a useful guide for the future development of DHIs targeted at South Asian and Black minority ethnic populations, with specific recommendations for improving cultural competency and promoting accessibility and inclusivity of design.

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BACKGROUND Digital health interventions (DHIs), have become increasingly common for the prevention and management of cardiometabolic disease. However, there is limited evidence for the suitability of these approaches in minority ethnic populations, who are at increased risk of these diseases. OBJECTIVE This study aims to investigate the use of digital health interventions (DHIs) for cardiovascular disease (CVD) and/or type 2 diabetes (T2DM) among minority ethnic populations in majority White, English-speaking countries; focussing on people who identify as South Asian, Black, and/or African-American. METHODS A realist methodology framework was followed, in which a literature search was conducted to develop context-mechanism-outcome configurations (CMOcs), including the contexts DHIs work in for the target minority ethnic groups, the mechanisms that these contexts trigger, and resulting health outcomes. After systematic searches, qualitative analysis of included studies was conducted using deductive and inductive coding. RESULTS 15 studies of uptake of DHIs for CVD and/or diabetes were identified, of which 13 focused on people from an African-American background. The review found evidence in support of the use of DHIs in minority ethnic populations when specific factors are considered in implementation and design, including: patient beliefs and health needs; education and literacy levels; material circumstances; culture, social networks and the wider community; and supporting healthcare systems. CONCLUSIONS The CMOcs developed in this review provide a useful guide for the future development of DHIs targeted at South Asian and Black minority ethnic populations, with specific recommendations on improving cultural competency, and promoting accessibility and inclusivity of design.

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