Did COVID-19 reduce the digital divide? A systematic review

Aim: This research paper aims synthesise literature evaluating how the increased use of digital health during the COVID-19 pandemic has impacted equitable access to healthcare in the United Kingdom (UK). Methods: A systematic literature review was adopted to get a broad overview of the impact of digital exclusion in the UK. To enable a structured analytical approach a three-domain framework was adopted ((1) digital access, digital literacy, and digital assimilation), and two specific groups were selected to investigate (older people and people with a lower socioeconomic status (SES)). Results: This review identified 17 relevant papers, of which 5 considered SES and 16 age, concerning equitable healthcare access via digital health in the UK. Three-domain framework analysis found that increased use of digital health during the COVID-19 pandemic had digitally excluded some groups, particularly people with a lower SES. 25 % of included studies identified negative outcomes associated with equitable access for older people, a figure which increased to 60 % in the lower SES analysis. Digital access and literacy were identified as key issues in the lower SES population, meanwhile behavioural factors, such as bounded learning and hassle costs, were identified as a key barrier in older adults. Notably, this review identified some studies where these barriers were effectively overcome, meaning that digital health was able to improve care access and experience for some older adults. This study also identified some cases where the use of digital health supported care to be effectively prioritised. Conclusion: Digital inclusion must become a higher policy priority in the UK. In the meantime, health systems should be mindful of potentially digitally excluded groups and ensure alternate modes of care (e.g. in-person and telephone) are effectively prioritised for those that need it most.