Bridging the digital health divide: a narrative review of the causes, implications, and solutions for digital health inequalities

Background: Digital health interventions have the potential to improve health at a large scale globally by improving access to healthcare services and health-related information, but they tend to benefit more affluent and privileged groups more than those less privileged. Methods: In this narrative review, we describe how this 'digital health divide' can manifest across three different levels reflecting inequalities in access, skills and benefits or outcomes (i.e. the first, second, and tertiary digital divide). We also discuss four key causes of this digital divide: (i)) digital health literacy as a fundamental determinant; (ii) other personal, social, community, and societal level determinants; (iii) how technology and intervention development contribute to; and (iv) how current research practice exacerbates the digital health divide by developing a biased evidence base. Finally, we formulate implications for research, policy, and practice. Results: Specific recommendations for research include to keep digital health interventions and measurement instruments up to date with fastpaced technological changes, and to involve diverse populations in digital intervention development and evaluation research. For policy and practice, examples of recommendations are to insist on inclusive and accessible design of health technology and to ensure support for digital health intervention enactment prioritises those most vulnerable to the digital divide. Conclusion: We conclude by highlighting the importance of addressing the digital health divide to ensure that as digital technologies' inevitable presence grows, it does not leave those who could benefit most from innovative health technology behind.