Centering Equity During Health Technology Innovation: Scoping Review of Methods and Research Adjustments to Promote...

Digital health has the potential to mitigate health inequity for priority populations who are underserved or marginalized by the health system. However, there is a lack of practical guidance on how to include priority communities in the coproduction of digital health technologies, particularly across the entire lifecycle of innovation, including research, development, and evaluation.

The aim of this scoping review was to systematically identify and assess published methods used during digital health innovation to promote equitable inclusion of priority communities at every stage of the Centre for eHealth Research roadmap for digital health technologies.

This review was based on the Arksey and O'Malley framework for scoping reviews. A 6-stage framework was used to execute the review. To increase the trustworthiness of the findings, an expert advisory group was consulted, and their feedback incorporated into the final manuscript. The Participant, Concept, and Context framework was used to structure the inclusion criteria.

The review identified a total of 106 articles, 58 methods, 4 approaches, and 17 research adjustments used to coproduce digital health technologies with priority communities. Common methods across multiple stages included interviews, focus groups, surveys, and workshops; however, the most accessible way to make equity a practical reality during health technology innovation is to appoint a priority population community advisor, or advisory group, from project inception to project closure. Visual and creative methods like photovoice, home tours, and body-mapping were also used, often by priority population researchers themselves. Research adjustments that promote patient safety and comfort, enhanced literacy, peer-support, and recognize sociocultural and demographic considerations have been used to increase the inclusion of priority populations during digital health innovation.

Embedding equity is possible using the practical methods and research adjustments identified to promote inclusive coproduction. Professionals working across health care, health informatics, research, digital health, and technology development can use these findings to center digital health equity during technology innovation. This research also recognizes that coproduction must draw on epistemological frameworks, or ways of thinking, which support Indigenous and other priority population knowledge systems. A solely Western lens risks reinforcing structural barriers and overlooking essential knowledge, as demonstrated by this review when the search strategy missed key scholarly works by priority population authors themselves.