Gill-Chevallier, Beatrice ORCID: https://orcid.org/0009-0002-9972-6516 (2025) Digital Health Equity in Primary Care: A Critical Review of Socioeconomic Barriers to Chronic Disease Management. pp. 1-18. (Submitted)

Abstract

Abstract Background: Integrating digital health technologies into chronic disease management has improved access, care continuity, and patient engagement. However, these benefits are unevenly distributed. Structural barriers impede digital engagement among socioeconomically disadvantaged older adults, perpetuating health inequities and constraining the effectiveness of digital innovations in primary care. This review critically examines the impact of unequal access to digital health tools on health outcomes and contributes to the broader discourse on digital health equity. Methods: A structured analysis was conducted using PubMed and CINAHL to identify original studies published between 2019 and 2024. Search terms were designed to capture research at the intersection of digital health, chronic disease, ageing, and social disadvantage in primary care. Studies were screened using PRISMA guidelines. Inclusion criteria focused on adults aged 65 and over from disadvantaged backgrounds living with chronic conditions. Seven studies were selected for thematic analysis. Results: The thematic analysis of seven studies revealed key factors shaping digital health outcomes: digital literacy, usability, mobile health, community-based interventions, low-cost tools, governance, and equity. Interventions demonstrated greater effectiveness when culturally tailored, accessible, and supported by training. Nonetheless, enduring structural barriers, including affordability, digital exclusion, and ineffective data governance, have a constrained impact, indicating that digital inequity is profoundly ingrained within the broader social determinants of health. Conclusion: Equitable digital health implementation necessitates more than mere access; it requires inclusive design, comprehensive professional training, and substantive policy reform. The role of nurses and primary care providers is pivotal in evaluating digital capacity and promoting equitable care delivery. This review offers evidence-based recommendations for equity-focused strategies to enable digital innovations to benefit, rather than exclude, socioeconomically disadvantaged older adults.

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