Understanding Inequalities in Mobile Health Utilization Across Phases: Systematic Review and Meta-Analysis

Area of Science:

• Digital Health
• Health Equity
• Mobile Health Interventions

Background:

• Mobile health (mHealth) offers potential for improved patient care but faces significant attrition, limiting its impact.
• Variations in mHealth access and adoption across populations and countries can worsen health inequalities and the digital divide.

Purpose of the Study:

• To systematically review and meta-analyze factors contributing to inequalities in mHealth utilization across access, adoption, adherence, and maintenance phases.
• To identify demographic, socioeconomic, and behavioral factors influencing equitable mHealth engagement.

Main Methods:

• Systematic review and meta-analysis of mHealth research from 2000-2024, including studies on smartphones, apps, and wearables.
• Inclusion of studies reporting inequality indicators across four mHealth phases; data extraction using a digital health equity framework.
• Random-effects meta-analysis for factors reported in at least three studies, assessing heterogeneity with the I² statistic.

Main Results:

• Older age negatively impacts mHealth adoption (OR 0.47). Higher education and income positively influence access and adoption.
• Employment, comorbidities, and private insurance show significant associations with mHealth access and adoption.
• Women and physically active individuals demonstrate higher mHealth adoption rates.

Conclusions:

• mHealth utilization is multifaceted, with inequalities present across all engagement phases.
• Tailored interventions are crucial to address phase-specific barriers and promote equitable mHealth use.
• Addressing digital access for vulnerable groups and promoting engagement through education and support can bridge health disparities.