What question did this study set out to answer?

The report aims to provide a structured framework for assessing digital health underutilisation in managing non-communicable diseases in low- and middle-income countries.

July 3, 2026Open Access

Beyond Access: A Multi-domain Framework for Assessing Digital Health Underutilisation in Non-communicable Disease Care in Low- and Middle-Income Countries

Key Points

The report aims to provide a structured framework for assessing digital health underutilisation in managing non-communicable diseases in low- and middle-income countries.
Developed a multi-domain framework incorporating structural access, individual capability, and health-system factors.
Outlined a practical stepwise implementation workflow for assessing digital health utilisation across various care settings.
Informed by operational experience from a structured outpatient digital-health assessment in Southern India.
Identified key domains affecting digital health underutilisation, including device access, digital literacy, and contextual barriers.
Proposed that digital health issues arise from complex interactions between technology and behavioural determinants, not just access.
Framework intended to be adaptable for broader non-communicable disease care environments.

Abstract

Digital-health technologies are increasingly being incorporated into the management of non-communicable diseases (NCDs); however, meaningful utilisation remains inconsistent in many low- and middle-income countries (LMICs) despite expanding digital infrastructure and telemedicine availability. Existing literature has largely focused on disease-specific interventions or individual digital-health tools, while structured, implementation-oriented frameworks for assessing digital-health underutilisation across diverse NCD settings remain limited. This technical report presents a practical multi-domain framework for assessing digital-health underutilisation in NCD care within LMIC settings. The framework conceptualises utilisation as a multidimensional process influenced by structural access, individual capability, behavioural readiness, and health-system factors. It incorporates assessment domains related to device and internet access, digital and eHealth literacy, attitudes toward digital-health use, contextual barriers, and integration within routine healthcare pathways. The report additionally outlines a stepwise implementation workflow intended to support structured assessment across outpatient, community, and chronic disease-care settings. The framework was informed by practical operational experience derived from structured outpatient digital-health assessment implemented within a tertiary-care setting in Southern India and is designed to remain adaptable across a broader range of NCD-care environments. Digital-health underutilisation in LMICs reflects a complex interaction of technological, behavioural, literacy-related, and health-system determinants rather than limitations in access alone. The framework presented in this report provides a practical and reproducible implementation-oriented approach for systematically evaluating barriers to digital-health utilisation and may support context-sensitive strategies for strengthening digital-health integration within NCD care.

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