Interpretive Frames to Understand the Contribution of Digital Exclusion to Health Inequalities: Hermeneutic Review

Background Digital exclusion is a multidimensional and relational process shaped by interactions among individuals, technologies, institutions, and wider social structures. Research on digital exclusion has expanded significantly in recent years, largely due to the COVID-19 pandemic and the rapid digitalization of health, welfare, and public services. Yet, despite this growth, conceptualizations of digital exclusion remain fragmented, limiting a comprehensive understanding of how digital exclusion contributes to the creation or intensification of health inequalities. Objective This hermeneutic review aims to develop an interpretive understanding of how digital exclusion has been conceptualized across diverse bodies of literature in relation to health inequalities. Methods We conducted a hermeneutic review using keyword searches and snowballing across PubMed, Scopus, and supplementary sources published between January 2020 and July 2025. Analysis involved repeated reading, note-taking, and comparative interpretation of each text’s disciplinary field, theoretical orientation, and underlying assumptions about how digital exclusion is framed in relation to health inequalities. Knowledge users contributed throughout to ensure the developing interpretations remained relevant to policy, practice, and lived experience. Results Thirty-one publications were included, spanning multiple disciplines and theoretical orientations. Five interpretive frames were identified: (1) inequality, which conceptualizes digital exclusion as arising from unequal social, economic, and material conditions; (2) power and social injustice, which highlights how institutional rules, governance arrangements, cultural norms, and service pathways condition who is recognized or supported, showing how digital systems can reproduce existing social hierarchies; (3) life transitions, which illustrates how exclusion shifts during periods of disruption or change, emphasizing the fluctuating conditions and vulnerabilities associated with major life changes; (4) psychobehavioral, which focuses on psychological, cognitive, and emotional responses to digital demands; and (5) sociotechnical misalignment, which frames exclusion as arising when digital systems do not align with people’s routines or everyday contexts. These interpretive frames show how digital exclusion is understood through different yet overlapping explanations that emphasize structural conditions, institutional practices, life circumstances, individual experiences, and service and system design. Conclusions This hermeneutic review identifies 5 interpretive frames that integrate diverse disciplinary perspectives on how digital exclusion contributes to health inequalities. The frames clarify the multiple, intersecting processes through which exclusion is produced and reproduced, helping to explain its persistence and uneven impacts. Our findings highlight the need for future research that examines structural and institutional mechanisms alongside lived experience and for digital health policy and practice to move beyond access- and skill-focused solutions toward approaches that address the multiple and interacting causes of digital exclusion.