How to design equitable digital health tools: A narrative review of design tactics, case studies, and opportunities

With a renewed focus on health equity in the United States driven by national crises and legislation to improve digital healthcare innovation, there is a need for the designers of digital health tools to take deliberate steps to design for equity in their work. A concrete toolkit of methods to design for health equity is needed to support digital health practitioners in this aim. This narrative review summarizes several health equity frameworks to help digital health practitioners conceptualize the equity dimensions of importance for their work, and then provides design approaches that accommodate an equity focus. Specifically, the Double Diamond Model, the IDEAS framework and toolkit, and community collaboration techniques such as participatory design are explored as mechanisms for practitioners to solicit input from members of underserved groups and better design digital health tools that serve their needs. Each of these design methods requires a deliberate effort by practitioners to infuse health equity into the approach. A series of case studies that use different methods to build in equity considerations are offered to provide examples of how this can be accomplished and demonstrate the range of applications available depending on resources, budget, product maturity, and other factors. We conclude with a call for shared rigor around designing digital health tools that deliver equitable outcomes for members of underserved populations.Author summary: Designers and developers of digital health tools, such as apps or telehealth services, have an opportunity to improve how their products support health equity. After the COVID-19 pandemic, the murder of George Floyd, and the passage of the 21st Century Cures Act, there are several forces in American society bringing attention to historical healthcare inequities and momentum to address them as we develop new products. We recommend practitioners start by consulting health equity frameworks to identify which dimensions, such as race, age, or health status, are most relevant to their product. From there, practitioners can choose established design tools like the Double Diamond Method, the IDEAS framework and toolkit, or community collaboration techniques like participatory design for their product development process and deliberately infuse a health equity focus. To demonstrate how that is possible across contexts, we offer case studies that range from lower-intensity equity research to enduring partnerships with community organizations serving underrepresented user groups. The goals of this paper are to equip practitioners to achieve more equitable outcomes via digital health tools and to contribute to standard methods of adopting an equity focus in digital health work.