A framework for digital health equity
Open accessAbstract
We present a comprehensive Framework for Digital Health Equity, detailing key digital determinants of health (DDoH), to support the work of digital health tool creators in industry, health systems operations, and academia. The rapid digitization of healthcare may widen health disparities if solutions are not developed with these determinants in mind. Our framework builds on the leading health disparities framework, incorporating a digital environment domain. We examine DDoHs at the individual, interpersonal, community, and societal levels, discuss the importance of a root cause, multi-level approach, and offer a pragmatic case study that applies our framework.
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Two recently published digital health frameworks for medical students outlined 27 artificial intelligence-specific competencies and 40 digital health topics, respectively.
“Two recently published digital health frameworks for medical students outlined 27 artificial intelligence-specific competencies 47 and 40 digital health topics, 48 respectively.”
From The Digital Health Competencies in Medical Education Framework (2025) · cites this paper as [47]
The Abstract and Introduction identify this as a framework for digital health equity intended for digital health tool creators and developers, not a framework for medical students. The paper describes digital determinants of health, not 40 digital health curriculum topics; the 27 AI competencies are attached to a separate citation in the citing sentence. (LLM, conf=0.87)
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Experimental — accuracy not yet measuredSocial determinants of health are important factors influencing care delivery, symptom management, and supportive care needs and also play an important role in the adoption and access to digital health solutions.
“We recognize, however, that social determinants of health are important factors influencing care delivery, symptom management, and supportive care needs and also play an important role in the adoption and access to digital health solutions.41”
From Implementation of a remote symptom monitoring pathway in oncology care: analysis of real-world experience across 33 cancer centres in France and Belgium (2024) · cites this paper as [41]
The Definitions section says social determinants of health affect health outcomes and include healthcare access and quality. The remote patient monitoring use-case section identifies social determinants affecting uptake of a digital tool used for care delivery and disease management. The paper does not specifically address their influence on symptom management or supportive care needs; no page numbers are available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredBased on the Digital Health Equity Framework, digital determinants of health and social determinants of health are intertwined factors that influence an individual's ability and opportunity to engage with digital health tools.
“Based on the Digital Health Equity Framework (Richardson et al., 2022), digital determinants of health (DDoHs) and social determinants of health (SDoHs) are intertwined factors that influence an individual’s ability and opportunity to engage with digital health tools.”
From Sociodemographics and Digital Health Literacy in Using Wearables for Health Promotion and Disease Prevention: Cross-Sectional Nationwide Survey in Germany (2025) · cites this paper as Richardson et al., 2022
The findings should be interpreted within the context of U.S.-based physicians using major commercial EHR platforms.
“Because this study examined U.S.-based physicians using major commercial EHR platforms, the findings should be interpreted within this context40.”
From When better data meets better design: How EHR data usability and system usability shape physicians' cognitive load (2026) · cites this paper as [40]
The Introduction discusses widespread EHR adoption in U.S. hospitals, but does not examine U.S.-based physicians using major commercial EHR platforms. The Community level determinants section discusses EHR infrastructure; neither passage addresses the stated study population or the proposed limit on interpreting its findings. Searches for the physician-and-platform description and for EHR-vendor generalizability found no supporting passage. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThese 2 frameworks involved experts from a single country in their development, which may limit their wider use.
“Nevertheless, these 2 frameworks involved experts from a single country in their development, which may limit their wider use.”
From The Digital Health Competencies in Medical Education Framework (2025) · cites this paper as [47]
The Abstract and the section on the NIMHD Research Framework describe this paper’s framework and the earlier framework it expands. Neither those passages nor the Discussion identifies the countries of the experts involved in developing the frameworks or says that single-country involvement may limit wider use. Searches for expert involvement, country, and international applicability found no passage establishing the claim. (LLM, conf=0.74)
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- Authors
- Richardson, S., Lawrence, K., Schoenthaler, A. M., & Mann, D.
- Affiliations
- New York University (US)
- Corresponding author
- Richardson, Safiya
- Venue
- npj Digital Medicine
- Published
- 2022-08-18
- Volume
- 5
- Issue
- 1
- Pages
- 119-119
- ISSN
- 2398-6352 (ISSN-L)
- PMC
- PMC9387425
- OpenAlex
- W4292202284
- Cited by
- 607
- References
- 42
- Citations by year
- 2026: 193 · 2025: 183 · 2024: 149 · 2023: 71 · 2022: 9
- FWCI
- 14.32
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- npj Digital Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Agency for Healthcare Research and Quality (R01 HS026522)
- National Heart, Lung, and Blood Institute (K23HL145114)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Health › Public Health and Social Inequalities
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Keywords
- digital health equity, digital determinants of health, health disparities, digital health tools, multilevel approach, root cause analysis, digital environment, health equity frameworks
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