Health equity in telehealth: applying a nine-dimension equity evaluation framework to two Australian programmes

Telehealth has expanded rapidly in Australia and internationally, particularly since the COVID-19 pandemic. Although promoted as a strategy to improve healthcare access, its implications for health equity remain contested. Existing evaluations often emphasise single aspects of access or broad equity principles without an operational structure for assessment across the programme lifecycle. This study aimed to develop and demonstrate a comprehensive framework for evaluating equity in telehealth programmes. A nine-dimension telehealth equity framework was developed by synthesising existing equity frameworks, evidence on telehealth access inequities and Australian telehealth policies, followed by iterative research-team refinement. It distinguishes five core dimensions that directly influence access and benefit and four supporting dimensions that enable sustained equitable services. The framework was applied to two Australian programmes with contrasting models and settings: RPA Virtual Hospital, a metropolitan tertiary-led virtual hospital, and the Virtual Rural Generalist Service, a rural hospital-based medical consultation model. Evidence came from programme documentation, peer-reviewed literature and stakeholder validation. Implementation depth was summarised using a heuristic 0–4 rubric. Application of the heuristic rubric produced different implementation profiles across the two cases. RPAV scored 4/4 for cultural adaptation and social inclusion, stakeholder engagement and collaborative governance, and healthcare system integration, 3/4 for five dimensions, and 2/4 for data privacy, security and trust. VRGS scored 2/4 for cultural adaptation and social inclusion and data privacy, security and trust, and 3/4 for the other seven dimensions. RPAV’s profile reflected formal cultural, navigation and governance supports, whereas VRGS’s profile reflected a nurse-facilitated rural service model with low patient-facing digital demands. Across both cases, the reviewed evidence showed limited public equity-stratified reporting of platform performance and clinical outcomes, unclear equity-related commissioning expectations and limited publicly visible accountability mechanisms. This proof-of-concept offers a structured way to examine telehealth equity across programme design, implementation and evaluation. Broader prospective testing, including independent dual scoring and service-user validation, is required before the framework is used for comparative performance assessment or as the basis of minimum equity reporting standards.