A systematic literature review to identify delivery strategies of digital health for low SEP populations

Abstract Background Inclusive implementation, tailored delivery of e-health applications, and support in e-health use could help overcome the digital divide between people with a low and a high socio-economic position (SEP). However, limited knowledge is available on how e-health and support is best delivered to people with a low SEP and whether these strategies are based upon scientific or experiential knowledge. This literature review aims to (1) provide an overview of strategies to deliver e-health to people with a low SEP, (2) offer insight into the effectivity in reach of people with a low SEP by these e-health delivery strategies, and (3) identify scientific and experiential underpinnings for e-health delivery strategies’ design. Methods This systematic review followed the PRISMA 2022 guidelines. A systematic search was conducted using five databases: PsycINFO, Web of Science, Embase, PubMed and Sociological Abstracts. Search terms were built around the following key-concepts: socio-economic position, e-health and delivery strategy. Delivery strategies were categorized according to five delivery strategy components: place, point-of-contact, promotion, facilitation and incentive. Results The search strategy yielded 5141 papers. The included papers (n = 35) described 33 studies. Place and point-of-contact strategies were most often applied and combined in e-health delivery. Some evidence for reach effectivity exists for the following strategies: e-health delivery at locations visited by target groups, delivery via authorities and via offline promotion. In health organization contexts, how and which healthcare professional delivers e-health is relevant for effective reach. Applied underpinnings for delivery strategy design included stakeholder involvement for implementation strategy design, and identification and operationalization of delivery strategies. Conclusion This literature review identified a gap in the existing knowledge concerning effective strategies for the delivery of e-health delivery to people with a low SEP. Results show that almost all strategies used multiple delivery strategy components of which place and point-of-contact were most common. The evidence regarding the reach effectiveness of delivery strategies is insufficient and too scattered to support definitive conclusions. Nonetheless, it offers valuable insights into potential effective approaches. Researchers report little on theoretical or experiential underpinnings used for the design of e-health delivery strategies, nor are real world evaluations often conducted. Registration: PROSPERO: CRD42024572294