Authors' objectives: Digital health interventions can support health-related knowledge transfer, for example through websites or mobile applications, and may reduce health inequalities by making health care available, where access is difficult, and by translating content to overcome language barriers. However, digital health intervention can also increase health inequalities due to the digital divide. To reach digitally excluded populations, design and delivery mechanisms need to specifically address this issue. This review was conducted during the evolving COVID-19 pandemic and informed the rapid design, deployment and evaluation of a post-COVID-19 rehabilitation digital health intervention: ‘Living with COVID Recovery’ (LWCR). LWCR needed to be engaging and usable for patients and to avoid exacerbating health inequalities. LWCR was introduced as a service into 33 NHS clinics, was used by 7679 patients, and evaluation ran from August 2020 to December 2022. To identify evidence-based digital health intervention design and deployment features conducive to mitigating the digital divide. Digital health interventions, such as websites and apps, can improve healthcare access, especially for people in remote areas or those with language barriers. However, they can also increase inequalities if not designed to address issues such as lack of access to technology or low digital skills. The review was conducted during the COVID-19 pandemic to help design the Living with COVID Recovery (LWCR) digital health intervention, a post-COVID rehabilitation tool used by over 7600 patients in 33 NHS clinics. The aim was to create a digital health intervention that was usable and engaging for people with different backgrounds to avoid worsening health inequalities.

Authors' results and conclusions: Twenty-two papers met the inclusion criteria. Digital health interventions evaluated included telehealth, text message interventions, virtual assistants, self-management programmes and decision aids. Design themes included Co-development with end-users, user testing through iterative design cycles, digital health interventions that also helped improve digital skills and digital health literacy, tailoring for low literacy through animations, pictures, videos and writing for low reading ages; virtual assistants to collect information from patients and guide the use of a digital health intervention. Using the design and deployment findings described above when developing digital health interventions may help overcome the digital divide. Beyond informing the LWCR digital health intervention development, the review findings have wider implications for the equitable design, delivery and evaluation of digital health interventions. The review’s findings highlight important steps that can help overcome the digital divide, including designing digital health interventions with users in mind, helping them to use the technology and supporting them skills they need. The results are intended to inform future digital health intervention development and evaluation and to lead to more equitable access to health care.

Authors' methods: Cochrane Library, Epistemonikos, National Institute for Health and Care Excellence Evidence, PROSPERO, PubMed (with MEDLINE and Europe PMC) and Turning Research into Practice; OpenGrey and Google Scholar were searched for primary research studies published in English from 1 October 2011 to 1 October 2021. Setting and population Adults who were likely to be affected by the digital divide, including older age, minority ethnic groups, lower income/education level and in any healthcare setting. Any digital health intervention with features of design and/or deployment intended to enable access and engagement by the population of focus. Co-development with end-users, user testing through iterative design cycles, digital health interventions that also helped improve digital skills and digital health literacy, tailoring for low literacy through animations, pictures, videos and writing for low reading ages; virtual assistants to collect information from patients and guide the use of a digital health intervention. Our search extended to late 2021, and there has been a massive increase in the literature following the pandemic. However, as our review was undertaken to inform the LWCR digital health intervention design and deployment, we have reported the results that informed this work. The studies included in the review were heterogeneous, so generalisability may be limited. Few randomised controlled trials assessed the digital health intervention’s impact on digital health skills by using validated measures. We searched online databases of research studies. We identified and analysed 22 studies with digital health interventions that aimed to improve access and engagement for underserved populations.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/NIHR132243

Year Published: 2025

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/published-articles/GJHG1331

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/GJHG1331

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk