Unlock digital health promotion in LMICs to benefit the youth

As digital technologies such as smartphones and fitness bands become more ubiquitous, individuals can engage in self-monitoring and self-care, gaining greater control over their health trajectories along the life-course. These technologies appeal particularly to young people, who are more familiar with digital devices. How this digital transformation facilitates health promotion is therefore a topic of animated debate. However, most research to date focuses on the promise and peril of digital health promotion (DHP) in high-income settings, while DHP in low- and middle-income countries (LMICs) remain largely unexplored. This narrative review aims to fill this gap by critically examining key ethical challenges of implementing DHP in LMICs, with a focus on young people. In the existing literature, we identified potential impediments as well as enabling conditions. Aspects to consider in unlocking the potential of DHP include (1) addressing the digital divide and structural injustice in data-related practices; (2) engaging the target population and responding to their specific needs given their economic, cultural, and social contexts; (3) monitoring the quality and impact of DHP over time; and (4) improving responsible technology governance and its implementation. Addressing these concerns could result in meaningful health benefits for populations lacking access to more conventional healthcare resources.Author summary: We conducted a narrative review exploring the ethical challenges of using digital technologies to promote health for young people living in low- and middle-income countries (LMICs). While smartphones and fitness bands are increasingly common, our understanding of their potential to improve health outcomes in LMICs, especially for young people, is still limited. Our review identifies several important factors for successful digital health promotion (DHP) in LMICs. First, we must address unfair data practices and the gap in access to technology. Second, it is crucial to engage young people and consider their specific needs within their economic, cultural, and social contexts. Third, monitoring the quality and impact of DHP over time is important to ensure its effectiveness. Finally, responsible technology governance and implementation needs improvement. Addressing these concerns could lead to significant health benefits for populations with limited access to traditional healthcare resources. This review contributes to the ongoing discussion on the benefits of DHP for youth, highlighting the importance of further research and action in LMICs.