Biondi Massimiliano, Filippetti Fabio, Brandi Giorgio, Ravaglia Elsa, Filippetti Sofia, Barbadoro Pamela
Medical Directorate, Fabriano Hospital Site, World Federation of Public Health Associations GHEDT WG, Ancona Health Authority AST AN, Via Stelluti Scala, 26, Fabriano, 60044, Italy, 39 0732 707111.
Prevention and Health Promotion Unit in Living and Working Places of the Marche Region, Ancona, Italy.
JMIR Infodemiology. 2025 May 30;5:e75495. doi: 10.2196/75495.
Health disparities persist and are influenced by digital transformation. Although digital tools offer opportunities, they can also exacerbate existing inequalities, a problem amplified by the COVID-19 pandemic and the related infodemic. Health equity audit (HEA) tools, such as those developed in the United Kingdom, provide a framework to assess equity but require adaptation for the digital context. Digital determinants of health (DDoH) are increasingly recognized as crucial factors influencing health outcomes in the digital era.
This editorial proposes an approach to extend HEA principles to create a specific framework, the digital health equity audit (DHEA), designed to systematically assess and address health inequities within the design, implementation, and evaluation of digital health technologies, with a focus on DDoH.
We propose a cyclical DHEA model based on existing HEA principles, integrating them with digital health equity frameworks. The DHEA cycle comprises six phases: (1) scoping the audit and mobilizing the team (including community members); (2) developing the digital health equity profile and identifying inequities (assessing DDoH at individual, interpersonal, community, and societal levels); (3) identifying high-impact actions to address DDoH and inequities; (4) prioritizing actions for maximum equity impact; (5) implementing and supporting change; and (6) evaluating progress and impact, and refining. This method emphasizes multilevel interventions and stakeholder engagement.
The main result is the articulation of the DHEA framework: a structured, 6-phase cyclical model to guide organizations in the analysis and proactive mitigation of digital health-related disparities. The framework explicitly integrates the assessment of DDoH across multiple levels (individual, interpersonal, community, societal) and promotes the development of targeted interventions to ensure digital solutions promote equity.
The DHEA model offers an integrated approach to consider social, epidemiological, health, and technological variables, aiming to reduce health inequities through the conscious use of new technologies. It is emphasized that digital technologies can be the cause or the solution to inequalities; DHEAs are proposed as a tool to foster equity. Its systematic adoption, along with a collaborative approach (co-design) and trust building, can help ensure that the benefits of health digitization are equitably distributed while strengthening trust in institutions. Continued attention is needed to manage emerging challenges such as infodemiology in the era of big data and artificial intelligence.
健康差距持续存在，并受到数字转型的影响。尽管数字工具带来了机遇，但它们也可能加剧现有的不平等，而新冠疫情及相关的信息疫情更是放大了这一问题。健康公平审计（HEA）工具，如英国开发的那些工具，提供了一个评估公平性的框架，但需要针对数字环境进行调整。健康的数字决定因素（DDoH）日益被视为数字时代影响健康结果的关键因素。
本社论提出一种方法，将HEA原则扩展以创建一个特定框架，即数字健康公平审计（DHEA），旨在系统地评估和解决数字健康技术的设计、实施和评估过程中的健康不平等问题，重点关注DDoH。
我们基于现有的HEA原则提出一个循环的DHEA模型，将其与数字健康公平框架相结合。DHEA循环包括六个阶段：（1）确定审计范围并动员团队（包括社区成员）；（2）制定数字健康公平概况并识别不平等现象（在个人、人际、社区和社会层面评估DDoH）；（3）确定解决DDoH和不平等现象的高影响力行动；（4）对具有最大公平影响的行动进行优先排序；（5）实施并支持变革；（6）评估进展和影响，并进行完善。该方法强调多层次干预和利益相关者参与。
主要成果是阐述了DHEA框架：一个结构化的、6阶段的循环模型，以指导组织分析和积极缓解与数字健康相关的差距。该框架明确整合了在多个层面（个人、人际、社区、社会）对DDoH的评估，并促进制定有针对性的干预措施，以确保数字解决方案促进公平。
DHEA模型提供了一种综合方法，用于考虑社会、流行病学、健康和技术变量，旨在通过有意识地使用新技术来减少健康不平等。需要强调的是，数字技术可能是不平等的根源，也可能是解决方案；DHEA被提议作为促进公平的一种工具。系统采用DHEA，以及采用协作方法（共同设计）和建立信任，有助于确保健康数字化的益处得到公平分配，同时增强对机构的信任。需要持续关注以应对大数据和人工智能时代信息疫情等新出现的挑战。
