Equity by design principles for digital health interventions.

Area of Science:

• Digital Health
• Health Equity
• Health Disparities

Background:

• Persistent health disparities highlight the need for equitable digital health interventions (DHIs).
• DHIs can widen the digital divide if equity is not integrated from the outset.
• A lack of actionable guidance for equity-centered DHI design exists.

Purpose of the Study:

• To develop evidence-based, equity by design principles for digital health interventions.
• To provide actionable guidance for researchers and practitioners in digital health.

Main Methods:

• Synthesized 42 articles/guidelines to formulate initial design principles (July-October 2024).
• Refined principles through three semi-structured expert interviews (November 2024-January 2025).
• Assessed practical applicability via end-user workshops with DHI providers (January-March 2025).

Main Results:

• Identified 25 equity by design principles: 15 for DHIs and 10 for organizational context.
• DHI principles cover needs assessment, design, implementation, and evaluation.
• Organizational principles address strategy, people, processes, and partnerships; identified 3 implementation challenges.

Conclusions:

• Addressing health inequities requires moving beyond DHI-specific design to include organizational context.
• Adopting these principles enables digital health companies to prioritize equity.
• Embedding equity can reduce health disparities and foster a more inclusive healthcare ecosystem.