Construction of the Digital Health Equity-Focused Implementation Research Conceptual Model - Bridging the Divide Between Equity-focused Digital Health and Implementation Research

Digital health implementations and investments continue to expand. As the reliance on digital health increases, it is imperative to implement technologies with inclusive and accessible approaches. A conceptual model can be used to guide equity-focused digital health implementations to improve suitability and uptake in diverse populations. The objective of this study is expand an implementation model with recommendations on the equitable implementation of new digital health technologies. The Digital Health Equity-Focused Implementation Research (DH-EquIR) conceptual model was developed based on a rigorous review of digital health implementation and health equity literature. The Equity-Focused Implementation Research for Health Programs (EquIR) model was used as a starting point and merged with digital equity and digital health implementation models. Existing theoretical frameworks and models were appraised as well as individual equity-sensitive implementation studies. Patient and program-related concepts related to digital equity, digital health implementation, and assessment of social/digital determinants of health were included. Sixty-two articles were analyzed to inform the adaption of the EquIR model for digital health. These articles included digital health equity models and frameworks, digital health implementation models and frameworks, research articles, guidelines, and concept analyses. Concepts were organized into EquIR conceptual groupings, including population health status, planning the program, designing the program, implementing the program, and equity-focused implementation outcomes. The adapted DH-EquIR conceptual model diagram was created as well as detailed tables displaying related equity concepts, evidence gaps in source articles, and analysis of existing equity-related models and tools. The DH-EquIR model serves to guide digital health developers and implementation specialists to promote the inclusion of health-equity planning in every phase of implementation. In addition, it can assist researchers and product developers to avoid repeating the mistakes that have led to inequities in the implementation of digital health across populations.Author summary: Digital health is becoming increasingly prevalent in our society, and it is essential that these technologies are designed with inclusivity and accessibility in mind. There are currently no comprehensive implementation models in digital health geared towards equity. To address this need, we developed a conceptual model called the Digital Health Equity-Focused Research Implementation framework. We completed a comprehensive review of existing literature on digital health implementation and digital health equity. The model merges the findings from this review into the existing Equity-focused Implementation Research model. The resulting digital health equity-focused implementation framework consists of five phases: assessing population health status, planning the program, designing the program, implementing the program, and equity-based outcomes. By promoting inclusivity and accessibility, the framework has the potential to improve the suitability and uptake of digital health technologies in diverse communities. By following this framework, researchers and developers can ensure that digital health equity planning is integrated into every step of the implementation process.