# Evaluation of health equity frameworks in telehealth and digital health: a systematic review and narrative synthesis

## TL;DR

This paper reviews health equity frameworks for telehealth and digital health to understand how they can help reduce healthcare access gaps.

## Contribution

The study evaluates and synthesizes existing health equity frameworks specifically for telehealth and digital health contexts.

## Key findings

- Thirteen unique health equity frameworks were identified, with six specifically developed for digital health contexts.
- Eight frameworks demonstrated moderate-to-high quality scores but still lack actionable guidance for real-world telehealth implementation.
- Current frameworks need adaptation to address telehealth-specific challenges like digital literacy and technology access.

## Abstract

The rise of telehealth and digital health solutions has been promoted as a transformative approach to bridging healthcare access gaps. However, these technologies may introduce new disparities related to digital literacy, Internet access, and technology affordability. While several health equity frameworks exist for traditional healthcare delivery, their applicability to telehealth contexts remains unclear.

We systematically searched MEDLINE, CINAHL, and Scopus databases for peer-reviewed articles discussing health equity frameworks relevant to telehealth and digital health. A narrative synthesis approach was employed, complemented by a tailored quality appraisal assessing Clarity, Theoretical Basis, Comprehensiveness, and Applicability to telehealth. Framework elements were categorized into drivers, measures, and enablers/modifiers of health equity.

The search yielded 707 records; after removing 25 duplicates, 27 full-text articles were assessed, and 17 were included in the final synthesis. Thirteen unique health equity frameworks were identified. Six frameworks were explicitly developed for digital health, telehealth, or eHealth contexts, while seven were general health equity frameworks with potential applicability to telehealth. Eight frameworks demonstrated moderate-to-high quality scores. Across frameworks, notable gaps remain in addressing telehealth-specific challenges and in providing actionable guidance for real-world implementation.

Existing frameworks provide valuable insights but require adaptation to address telehealth-specific challenges fully. Tailored frameworks that incorporate digital determinants of health, prioritize equitable access to technology, and facilitate system integration are essential. These advancements will enable telehealth to effectively reduce health disparities and advance equity in healthcare access.

https://www.crd.york.ac.uk/PROSPERO/view/607575, Identifier PROSPERO (CRD42024607575).