Multilevel Determinants of Digital Health Equity: A Literature Synthesis to Advance the Field

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Abstract

Current digital health approaches have not engaged diverse end users or reduced health or health care inequities, despite their promise to deliver more tailored and personalized support to individuals at the right time and the right place. To achieve digital health equity, we must refocus our attention on the current state of digital health uptake and use across the policy, system, community, individual, and intervention levels. We focus here on ( a) outlining a multilevel framework underlying digital health equity; ( b) summarizingfive types of interventions/programs (with example studies) that hold promise for advancing digital health equity; and ( c) recommending future steps for improving policy, practice, and research in this space.

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Most cited references 96

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During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health promotion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease. This article proposes an ecological model for health promotion which focuses attention on both individual and social environmental factors as targets for health promotion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes.

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This article examines health promotion and disease prevention from the perspective of social cognitive theory. This theory posits a multifaceted causal structure in which self-efficacy beliefs operate together with goals, outcome expectations, and perceived environmental impediments and facilitators in the regulation of human motivation, behavior, and well-being. Belief in one's efficacy to exercise control is a common pathway through which psychosocial influences affect health functioning. This core belief affects each of the basic processes of personal change--whether people even consider changing their health habits, whether they mobilize the motivation and perseverance needed to succeed should they do so, their ability to recover from setbacks and relapses, and how well they maintain the habit changes they have achieved. Human health is a social matter, not just an individual one. A comprehensive approach to health promotion also requires changing the practices of social systems that have widespread effects on human health.

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Author and article information

Journal

Title: Annual Review of Public Health

Abbreviated Title: Annu. Rev. Public Health

Publisher: Annual Reviews

ISSN (Print): 0163-7525

ISSN (Electronic): 1545-2093

Publication date Created: April 03 2023

Publication date (Print): April 03 2023

Volume: 44

Issue: 1

Pages: 383-405

Affiliations

[1 ]Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California–San Francisco, San Francisco, California, USA;

[2 ]Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, California, USA

[3 ]Center for Vulnerable Populations, University of California–San Francisco, San Francisco, California, USA

[4 ]School of Public Health, University of California–Berkeley, Berkeley, California, USA

[5 ]Department of Medicine, Division of Hospital Medicine at Zuckerberg San Francisco General Hospital, University of California–San Francisco, San Francisco, California, USA

[6 ]Chan Zuckerberg Biohub, San Francisco, California, USA

[7 ]School of Social Welfare, University of California–Berkeley, Berkeley, California, USA

[8 ]Department of Psychiatry, University of California–San Francisco, San Francisco, California, USA

Article

DOI: 10.1146/annurev-publhealth-071521-023913

PubMed ID: 36525960

SO-VID: a7485de9-5d79-430d-b547-5dfe95a47ae8

License:

http://creativecommons.org/licenses/by/4.0/

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