Digitization and health inequality and equity in nursing

Abstract

Abstract. Background: The use of information and communication technologies (ICT) in health care is increasing attention. To describe health inequalities and equity with regard to the use of digital health technologies in a care context and to understand interrelationships, it is of particular importance for the field of care research to use models and theories that explain health inequalities and equity in the use of digital technologies. Aims: This article aims to identify models and theories from the field of nursing and health research that explain the phenomenon of health inequalities and the influence of digital health technologies on the emergence of inequalities. Methods: Relevant articles were searched in electronic databases (MEDLINE, CINAHL & SocINDEX) between July and August 2019 in German and English, within the methodological framework of a scoping review. The systematic literature search and data extraction were performed by 2 reviewers. The description of data refers to standard criteria by 8-1Christiansen and Baum (1997). Results: From a total of 25 relevant articles, 2 were identified for inclusion in the current overview. One model is focusing on ICT for health and the other model focuses on eHealth. No nursing theory could be identified in the context of describing the phenomenon of digital inequality. Conclusions: In both models, there is a lack of discussion about the impact of nursing aspects on the use and acceptance of eHealth technologies. One point should also be the development of models and theories that consider the user perspective of vulnerable groups.

Methods, Indicators, and End-User Involvement in the Evaluation of Digital Health Interventions for the Public: Scoping Review

“…This complexity is partly due to their interdisciplinary and multisectoral nature, involving a diverse mix of stakeholders, including patients, various health professionals, relatives, policymakers, and health insurers [1,3,8,15]. Additionally, DHIs consist of multiple interdependent components, both technical and nontechnical [4,8,15], and serve multiple aims, such as providing information, improving communication, facilitating data sharing, and enabling monitoring [1]. The value and impact of DHIs extend beyond clinical outcomes and also encompass organizational, behavioral, and technical dimensions [7].…”

“…Although RCTs are considered as the gold standard [6], especially in the context of evaluating DHIs, they are a much-discussed topic. Due to the complexity of DHIs, the applicability of RCTs is widely criticized [3,6,9,15,16,18]. A comprehensive evaluation of DHIs is essential for generating robust evidence [14,20], contributing to their long-term successful implementation and aiding in the realization of the full benefits of DHIs [15,20].…”

“…Due to the complexity of DHIs, the applicability of RCTs is widely criticized [3,6,9,15,16,18]. A comprehensive evaluation of DHIs is essential for generating robust evidence [14,20], contributing to their long-term successful implementation and aiding in the realization of the full benefits of DHIs [15,20]. This principle also applies to DPHIs, which should adhere to an evidence-and needs-based approach, incorporating a participatory user-targeted development design to enhance acceptance of the intervention within the population [11,13,21].…”

“…The literature describes considerable variability and heterogeneity in how DHIs should be evaluated, which is attributable to the absence of a standardized, established, and broadly applicable approach for evaluating DHIs [3,6,15,20,[22][23][24][25]. One possible explanation for the absence of a standardized and broadly applicable guideline for the evaluation of DHIs is that the evaluation of these technologies is complex and complicated by various fundamental issues [17].…”

“…For various reasons, such as counteracting the nonuse of DHIs as well as DPHIs, evidence generation and evaluation should be practice-oriented, necessitating the integration of end users in this process [3,11,13,15,21,[25][26][27][28]. In recent years, approaches, such as user-centered design (UCD), participatory health research (PHR), and public and patient involvement (PPI), have gained increasing importance in the health care sector, each contributing to the overarching goal of creating patient-centered, accessible, and equitable health care solutions.…”