Digital exclusion in healthcare services: a scoping review

BACKGROUND: With the widespread adoption of digital technologies in healthcare, digital exclusion-the phenomenon in which individuals are excluded from digital technologies due to a lack of access, skills, motivation, and other factors-has emerged as a significant contributor to health inequities. However, conceptual ambiguity, inconsistent measurement approaches, and an unclear impact on health outcomes within healthcare settings limit the development of effective strategies to address digital exclusion. This scoping review aims to clarify the concept and dimensions of digital exclusion in healthcare, examine its measurement methods, and understand its effects on health. METHODS: A scoping review was conducted following the PRISMA-ScR guidelines for reporting. A systematic search was performed in PubMed, CINAHL, Emerald, Web of Science Core Collection, PsycINFO, Ovid, Embase, IEEE Xplore, and Google Scholar for English-language literature published up to December 1, 2024. Two independent reviewers performed screening and data extraction, and findings were synthesized narratively using thematic analysis. RESULT: The initial search retrieved 3,392 studies. A total of 39 studies were finally included. The concept of digital exclusion can be categorized into three levels focusing on access, user capabilities, and meaningful outcomes. Thematic analysis identified five core dimensions: affordability barriers, technical resource barriers, digital competence, psychological barriers, and usage and support barriers. Nineteen assessment tools were identified, including 16 individual-level and 3 population-level instruments. However, most lacked validation and were not designed specifically for healthcare contexts. Evidence indicates that digital exclusion is associated with various adverse health outcomes, including restricted access to medical resources, psychosocial problems, cognitive and functional decline, and increased disease risk and poorer prognosis. CONCLUSION: Digital exclusion in healthcare is a multidimensional, complex phenomenon with significant negative impacts on health. Future research should deepen conceptual understanding within healthcare contexts, develop validated clinical assessment tools, and investigate mechanisms through which digital exclusion affects a broad range of health outcomes, thereby promoting equitable access to digital health services.