Rethinking the digital divide in health: a critical interpretive synthesis of research literature

Background: The digital divide in health has rapidly expanded during and after the COVID-19 pandemic, with fragmented understanding and an unclear implementation process, for the formal integration of digital health into the healthcare system, which challenges actionable policy development. Methods: This critical interpretive synthesis (CIS) of the literature aimed to capture the complexity of the digital divide in health. This began with a scoping review of literature published between 2013 and 2023 describing the digital divide in health within the WHO's European Region, in Web of Science, Medline (via Ovid), PsycInfo (via Ovid), and Sociological Abstract (via ProQuest). Three sets of two reviewers independently conducted the selection, and all contributed to the synthesis process. Results: Of 4,967 original articles identified, 49 articles were included for review. Results revealed a synthesizing argument that the digital divide should be considered as more of a dynamic, entangled, and reciprocal collection of "areas" of phenomenon affecting service users, rather than "levels". Results describe the three synthetic constructs that describe this synthesizing argument. Conclusion: Findings suggest that digital health solutions should respectfully consider the pace of human healing, long-term user engagement and adaptability. We call for the importance of inter- and multidisciplinary collaboration to ensure effective and context-sensitive implementation in future studies.