背景:在COVID-19大流行期间,随着服务转移到基于网络的平台,医疗保健中数字技术的使用迅速增加。公平领域中的数字健康不平等尚未得到例行检查;然而,数字交付服务的长期整合需要考虑这种不平等,以确保公平利益。
目标:这项范围审查旨在绘制访问中的不平等,使用,并参与跨股权领域的数字健康技术。
方法:我们搜索了4个电子数据库(MEDLINE,ASSIA,PsycINFO,和Scopus),用于2016年1月至2022年5月之间发布的定量和混合方法评论和荟萃分析。评论仅限于世界卫生组织欧洲地区的研究。提取的数据与Cochrane的PROGRESSPLUS(居住地,种族,种族,文化,和语言,职业,性别和性别,宗教,教育,社会经济地位,社会资本,和其他特征)公平的维度。
结果:总计,从搜索中确定了404个独特的引文,并从其他来源确定了2个引用。资格评估后,包括22条评论。一致的证据表明,白人患者更容易获得数字健康技术,说英语,没有残疾。没有评论探讨了按年龄划分的数字医疗保健的获取差异,性别和性别,职业,教育,或无家可归或物质滥用。在白人人群中观察到数字健康技术的使用更高,说英语,年轻,有了更高的教育水平,较高的经济地位,和城市地区的居民。没有明确的证据表明职业在使用数字技术方面存在差异,性别和性别,残疾,或无家可归或发现物质滥用,在有关数字技术参与不平等的评论中也没有明确的证据。最后,没有发现按居住地调查差异的评论。
结论:尽管认识到数字健康不平等的潜在影响,在多个股权领域存在重要的证据差距。需要制定一个共同框架,以评估新卫生举措中的数字卫生公平性以及报告结果的一致性。
The use of digital technologies within health care rapidly increased as services transferred to web-based platforms during the COVID-19 pandemic. Inequalities in digital health across the domains of equity are not routinely examined; yet, the long-term integration of digitally delivered services needs to consider such inequalities to ensure equitable benefits.
This scoping
review aimed to map inequities in access, use, and engagement with digital health technologies across equity domains.
We searched 4 electronic databases (MEDLINE, ASSIA, PsycINFO, and Scopus) for quantitative and mixed methods reviews and meta-analyses published between January 2016 and May 2022. Reviews were limited to those that included studies from the World Health Organization\'s European region. Extracted data were mapped against Cochrane\'s PROGRESS PLUS (place of residence, race, ethnicity, culture, and language, occupation, gender and sex, religion, education, socioeconomic status, social capital, and other characteristics) dimensions of equity.
In total, 404 unique citations were identified from the searches, and 2 citations were identified from other sources. After eligibility assessment, 22 reviews were included. Consistent evidence was found showing higher access to digital health technologies among patients who were of White ethnicity, were English speaking, and had no disability. There were no reviews that explored differences in access to digital health care by age, gender and sex, occupation, education, or homeless or substance misuse. Higher use of digital health technologies was observed among populations that were White, English speaking, younger, with a higher level of education, of higher economic status, and residents in urban areas. No clear evidence of differences in the use of digital technologies by occupation, gender and sex, disability, or homeless or substance misuse was found, nor was clear evidence found in the included reviews on inequalities in the engagement with digital technologies. Finally, no reviews were identified that explored differences by place of residence.
Despite awareness of the potential impact of inequalities in digital health, there are important evidence gaps across multiple equity domains. The development of a common framework for evaluating digital health equity in new health initiatives and consistency in reporting findings is needed.