Evaluation of health equity frameworks in telehealth and digital health: a systematic review and narrative synthesis

Introduction: The rise of telehealth and digital health solutions has been promoted as a transformative approach to bridging healthcare access gaps. However, these technologies may introduce new disparities related to digital literacy, Internet access, and technology affordability. While several health equity frameworks exist for traditional healthcare delivery, their applicability to telehealth contexts remains unclear. Methods: We systematically searched MEDLINE, CINAHL, and Scopus databases for peer-reviewed articles discussing health equity frameworks relevant to telehealth and digital health. A narrative synthesis approach was employed, complemented by a tailored quality appraisal assessing Clarity, Theoretical Basis, Comprehensiveness, and Applicability to telehealth. Framework elements were categorized into drivers, measures, and enablers/modifiers of health equity. Results: The search yielded 707 records; after removing 25 duplicates, 27 full-text articles were assessed, and 17 were included in the final synthesis. Thirteen unique health equity frameworks were identified. Six frameworks were explicitly developed for digital health, telehealth, or eHealth contexts, while seven were general health equity frameworks with potential applicability to telehealth. Eight frameworks demonstrated moderate-to-high quality scores. Across frameworks, notable gaps remain in addressing telehealth-specific challenges and in providing actionable guidance for real-world implementation. Conclusion: Existing frameworks provide valuable insights but require adaptation to address telehealth-specific challenges fully. Tailored frameworks that incorporate digital determinants of health, prioritize equitable access to technology, and facilitate system integration are essential. These advancements will enable telehealth to effectively reduce health disparities and advance equity in healthcare access. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/607575, Identifier PROSPERO (CRD42024607575).