Desperately Seeking the Intersectionality in Digital Health Disparities Research: Towards a Richer Theorisation of Multiple Disadvantage (Preprint)

BACKGROUND The COVID-19 pandemic has led to the rapid scale up in the use of video consultations in general practice across the UK, but the impact this has had on digital health disparities concerning certain disadvantaged groups of patients remains largely unknown. OBJECTIVE We set out to review the research on digital disparities in relation to ethnicity, language and age, with a view to understanding how older individuals with limited fluency in English fare when it comes to participating in video consultations. This narrative review further explores how the intersecting effects of age, socio-economic status and limited English proficiency have been conceptualised, theorised and studied empirically in relation to the provision of digital access and services between 2012-2021. METHODS After assessing 50 articles identified from multiple sources, 31 were excluded and 19 were analysed using these criteria: remote consultations (or virtual consultations or video consultations); barrier (or limitations or challenge or enabler or facilitator or access); digital health inequality (or digital divide or inequity/ies or inequality/ies health disparit/ies). RESULTS The literature search found nine commentaries and 10 peer-reviewed research papers which comprised of one systematic review, one narrative review, one retrospective audit of medical records, two quantitative surveys and five qualitative studies based on semi-structured interviews. Formal research studies on this topic in the early months of the pandemic were few, mostly small and rapidly conducted. Research in relation to video consultations to date, has been almost entirely descriptive. Our dataset included no in-depth, theoretically-informed empirical studies that were able to explain how different dimensions of disadvantage combined to impact on digital health disparities. CONCLUSIONS Our findings show that the available literature reports substantial digital disparities. We identified three theoretical approaches that may be mobilised to account for these digital disparities: fundamental cause theory, digital capital theory, and intersectionality theory. The current literature on digital health disparities is in need of richer theorisation to generate explanations of how different dimensions of disadvantage interact. The current lack of attention to the intersectionality of multiple disadvantages in digital health research represents both a unique opportunity and an important challenge. We call for greater use of interdisciplinary theories of health disparities and technological innovation to inform future digital health research.