Western Max J, Smit Eline S, Gültzow Thomas, Neter Efrat, Sniehotta Falko F, Malkowski Olivia S, Wright Charlene, Busse Heide, Peuters Carmen, Rehackova Lucia, Gabriel Oteșanu Angelo, Ainsworth Ben, Jones Christopher M, Kilb Michael, Rodrigues Angela M, Perski Olga, Wright Alison, König Laura
Centre for Motivation and Behaviour Change, University of Bath, Bath, UK.
University of Amsterdam/ASCoR, Amsterdam, The Netherlands.
Health Psychol Behav Med. 2025 Apr 23;13(1):2493139. doi: 10.1080/21642850.2025.2493139. eCollection 2025.
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. 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. 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. 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.
数字健康干预措施有潜力通过改善医疗服务和健康相关信息的获取，在全球范围内大规模改善健康状况，但它们往往使较富裕和享有特权的群体比弱势群体受益更多。在这篇叙述性综述中，我们描述了这种“数字健康鸿沟”如何在反映获取、技能以及收益或结果方面不平等的三个不同层面显现出来（即第一、第二和第三数字鸿沟）。我们还讨论了造成这种数字鸿沟的四个关键原因：（i）数字健康素养作为一个基本决定因素；（ii）其他个人、社会、社区和社会层面的决定因素；（iii）技术和干预措施的发展如何促成；以及（iv）当前的研究实践如何通过建立有偏差的证据基础加剧数字健康鸿沟。最后，我们阐述了对研究、政策和实践的启示。对研究的具体建议包括使数字健康干预措施和测量工具跟上快速的技术变革，并让不同人群参与数字干预措施的开发和评估研究。对于政策和实践，建议的例子包括坚持健康技术的包容性和可及性设计，并确保对数字健康干预措施实施的支持优先考虑那些最易受数字鸿沟影响的人群。我们最后强调解决数字健康鸿沟的重要性，以确保随着数字技术不可避免地日益普及，不会让那些最能从创新健康技术中受益的人掉队。
