A conceptual framework and umbrella review of digital health technology interventions and health equity

Evidence on digital health interventions is rapidly emerging, but how health equity is being addressed remains uncertain. This study presents a conceptual framework that identifies causal pathways linking digital health and health equity, serving as an intervention logic model onto which existing and future evidence can be mapped. As an application of this framework, we conduct an umbrella review to map and narratively summarize published systematic reviews on the effectiveness, acceptability, and feasibility of digital health technology interventions. Systematic reviews were searched in electronic databases from 2005 until March 4, 2025, with a focus on chronic disease. Information on study characteristics, digital health technologies, and health equity considerations was extracted. Methodological quality was assessed using the AMSTAR-2 tool. Thirty-five studies met the eligibility criteria. The most prevalent intervention group was telemedicine, while clinical decision support systems were not the focus of any of the included studies. The systematic reviews varied markedly in quality, with most being equity-focused and addressing more than one dimension of horizontal inequality. Extending the mapping of existing research using the developed framework to other pathways—between digital health, health behaviours, and health outcomes—will help to better inform the design of interventions aimed at addressing the digital divide. Future studies should conduct equity-focused meta-analyses for specific interventions, health outcomes, and decision-making contexts.