[Unintended consequences and side effects of digital health technology: a public health perspective]

The discussion of digital health technologies, in particular medical and health apps, is currently dominated by a focus on their potential to reach large parts of the population for the dissemination of evidence-based health promotion and prevention content. However, potentially unintended consequences, side effects, and negative effects of digital health technologies are rarely discussed in public health.In this paper, via a narrative literature review, we propose a perspective on unintended consequences and side-effects of digital health technologies on multiple hierarchical levels of a socio-ecological model of health. Unintended consequences and side-effects of digital health technologies can be identified on an individual level, a level of social relationships, and a health services level.We propose a broader conceptualization of unintended consequences and side-effects of digital health technology together with a more thorough documentation of such effects using multiple levels in a socio-ecological approach. This would build a cumulative evidence base of unintended effects and shift the focus from development-centered discussion of risks and challenges to a comprehensive conception of side effects and undesirable effects of digital health technologies. The proposed division into three effect levels may be helpful here.