Aims: Digital health applications, such as information and support websites, mobile apps, telehealth, and wearables can support care for people with cancer. However, research indicates disparities occur in digital health benefit realisation for some population groups due to "digital exclusion", which refers to access, affordability, usage, skills, and relevance of digital technologies. This study is a sub-analysis of a systematic meta-review of literature on digital health in cancer care, which aimed to explore disparity issues identified in the review papers.
Methods: A systematic literature review of review papers, guidelines and recommendations pertaining to digital health applications and cancer care, published from January to July 2018, was undertaken to identify barriers, enablers, and high priority needs in the implementation of digital health applications in cancer care. The themes related to barriers to, and enablers for, implementation relevant to disparity in digital health in cancer care were identified.
Results: The literature search identified 93 review papers focusing on digital health applications in cancer care. Of these, 57 (61%) identified issues for implementation within the theme of disparity and inclusivity, across all digital health modalities reviewed Forty-five papers (79%) identified barriers and 36 (63%) identified enablers. Whilst digital health was seen as increasing access to services for underserved areas and populations, including in remote areas and developing countries, disparities were also evident due to barriers including age, technological/digital literacy, health literacy, language, ethnicity, and socioeconomic disadvantage. Personalisation/tailoring offered potential to reduce these disparities.
Conclusion: This research identified the potential for digital health to reduce disparity and increase inclusivity in cancer care; however, the potential for digital exclusion to increase disparities in cancer outcomes in underserved groups was observed. Digital health applications need to be strategically implemented in such a way that they reduce, rather than increase, existing disparities in access to cancer care.