The DigitALL Model for Equity-based Digital Health
To ensure quality of care for all, digital health approaches must be developed with greater attention to the needs of diverse users and groups of people. While there is cause to celebrate the potential of technologies to increase access to care, and to distribute health resources to underserved, rural, and remote areas, there is growing awareness that digital health technologies and virtual care can have unintended impacts of increasing health inequities and “widening the digital divide.” The rapid transition to virtual care during the Covid-19 pandemic brought digital health equity to the fore.
The digital health equity framework (DHEF) integrates many health equity factors with digital determinants of health and is central to the DigitALL Model for Equity-based digital health. To learn more, see Digital Health Equity and COVID-19: The Innovation Curve Cannot Reinforce the Social Gradient of Health in The Journal of Medical Internet Research (Crawford & Serhal, 2020).
Simplified version of the Digital Health Equity Framework
At the core of the DigitALL model are the key dimensions of quality of care, with an emphasis on person-centered care; safety, including psychological and cultural safety; and equity. While the process of evaluating health equity is likely to surface risks for inequities and barriers to care, we strongly center strengths-based approaches, recognizing the many talents and resources brought by individuals and communities.
Providing care should not undermine the autonomy of individuals and communities; efforts should be made to promote health leadership from within communities, with requisite resources also going to communities.
The outer ring in the diagram are the steps that can be taken as part of a digital health-focused equity impact assessment.
The Health Equity Impact Assessment – Digital Health Supplement (HEIA-DH)
The HEIA-DH is a tool to guide the identification of barriers to digital health equity in a health service, program, or intervention. The HEIA-DH enables researchers, clinicians, administrators, policy makers, patient partners, community members, and healthcare partners to come together to discuss equity considerations for a specific technology/service.
The HEIA-DH tool guides participants through a series of iterative steps to assess impacts and mitigation strategies:
- Scoping - discuss social and digital determinants of health as they relate to the specific service or technology;
- Potential Impacts – identify unintended impacts of the technology/service;
- Mitigation - how to address these impacts through mitigation strategies;
- Monitoring - how we can meaningfully evaluate our progress in increasing equity; and
- Dissemination – how we can shar e these findings to increase equity.
Collaborating to Ensure Digital Health Equity
A seminar presentation by Dr. Allison Crawford at the University of Manchester.