The approach follows the methodological framework by Arksey and O’Malley [
Overview of the scoping review workflow. HF: heart failure.
Adults (≥18 years) with any type of heart failure
Studies reporting on digital health technologies (World Health Organization definition)
Observational studies (cross-sectional, cohort, case-control)
Studies that report social determinants of health, geography, or race/ethnicity
Full-text articles published in English in peer-reviewed journals
Any publication year
Randomized controlled trials, qualitative-only studies
Conference abstracts, editorials, letters, non–peer-reviewed sources
Non–English language publications
Domains of social drivers used to examine inequity.
| Data domain | Definition |
| Social determinants of health | Insurance Income/wealth Marital status Educational attainment Neighborhood socioeconomic status Social support Employment status Health literacy |
| Geography | Urban/rural residency Distance to hospital Administrative regions |
| Race and ethnicity | Any group |
A professional health care librarian was consulted to build the search strategy (
Search strategy. Search query: number 1 AND number 2 AND (number 3 OR number 4 OR number 5 OR number 6).
| Number | Topic | Database | |||
| Embase | PubMed | Google Scholar | Scopus | ||
| 1 | “heart failure”/exp OR “heart failure” | “Heart Failure” [Mesh] OR “heart failure” | “heart failure” | “heart failure” | |
| 2 | Digital health intervention | (“digital intervention”/exp OR “digital intervention” OR (“digital” AND (“intervention”/exp OR “intervention”))) OR (“digital health”/exp OR “digital health”) OR (“mobile application”/exp) (“information technology device”/exp) OR (“digital technology”/exp) OR (“telehealth”/exp) OR (“mhealth”/exp) OR “mhealth” OR “mobile health” | “Telecommunications” [Mesh] OR “digital intervention” OR “digital health intervention” OR (“digital” AND “intervention”) OR “mHealth” OR “mobile health” | “digital intervention” OR “mHealth” OR “mobile health” | “digital intervention” OR (“digital” AND “intervention”) OR “mHealth” OR “mobile health” |
| 3 | Health inequity | “health disparity”/exp OR “disparity in health” OR “health disparities” OR “health economic disparity” OR “health inequality” OR “health inequities” OR “health inequity” OR “health social disparity” OR “health social economic disparity” OR “health social inequality” OR “health socio-economic disparity” OR “health socioeconomic disparity” OR “health socioeconomic inequity” OR “health status disparities” OR “health status disparity” OR “health status inequality” OR “health status inequity” OR “inequality in health” OR “inequity in health” OR “socioeconomic disparities in health” OR “health disparity” | “Health Inequities” [Mesh] OR “inequity” OR “inequities” OR “disparity” OR “disparities” | “inequity” OR “disparity” | “inequity” OR “inequities” OR “disparity” OR “disparities” |
| 4 | Social determinants of health | “social determinants of health”/exp OR “social determinant” OR “social determinants” OR “social determining factor” OR “social factors determining health” OR “social health determinant” OR “social determinants of health” | “Social Determinants of Health” [Mesh] OR “social determinant of health” | “Social Determinants of Health” | “Social Determinants of Health” OR “social determinant of health” |
| 5 | Geographic variation | “geography”/exp OR “geographic factor” OR “geographic locations” OR “geography” OR “geography”/exp OR “geographic factor” OR “geographic locations” OR “geography” OR “geographic distribution”/exp OR “distribution, geographic” OR “geographical distribution” OR “geographic distribution” OR “geographic variation”/exp OR “urban area”/exp OR “built-up area” OR “built-up land” OR “urban environment” OR “urban land” OR “urbanized area” OR “urbanized environment” OR “urbanized land” OR “urbanized area” OR “urbanized environment” OR “urbanized land” OR “urban area” OR “rural area”/exp OR “agricultural area” OR “rural environment” OR “rural land” OR “rural area” | “Population” [Mesh] OR “geographic variation” OR “geography” | — | “geography” OR “geographic variation” OR “rural” OR “urban” |
| 6 | Race/ ethnicity | “ethnic group”/exp OR “ethnic and racial groups” OR “ethnic and racial minorities” OR “ethnic groups” OR “ethnic minorities” OR “ethnic minority” OR “ethnic origin” OR “ethnic population” OR “ethnic status” OR “ethno-linguistic group” OR “ethnolinguistic group” OR “ethnic group” | “Ethnicity” [Mesh] OR “ethnicity” OR “ethnic” OR “Racial Groups”[Mesh] OR “race” | — | “ethnicity” OR “ethnic” OR “race” OR “racial” |
aNot applicable.
Two independent reviewers (NV and ME) will use a 2-step screening approach. First, all identified records will be manually screened for eligibility based on titles and abstracts. Second, the full-text reports of the qualifying abstracts will be assessed for eligibility. Finally, the 2 reviewers will screen the list of references of the selected studies. Any inconsistencies will be resolved by formal consensus, which will involve SPJ.
Based on the identified literature, NV and ME will independently extract data following the data charging form: (1) authors and year of publication (2); study design and population; (3) aims of the study (4); study location and calendar period; (5) care setting (eg, inpatient, outpatient, or home-based); (6) digital health technology modality; (eg, telemonitoring, mobile app, or wearable); (7) operational definitions of “access” (availability and ability to obtain or use technology) and “use” (actual engagement or use); (8) equity indicators (income, education, race/ethnicity, geography, and insurance status); (9) reimbursement and connectivity context (insurance coverage, internet access, and device ownership); (10) primary outcome measure; (11) main findings, reported according to age, sex, socioeconomic characteristics, geographic characteristics, and race/ethnicity.
We will systematically organize and present the findings.
Reported measures of association (eg, odds ratios, risk ratios, and hazard ratios) will be tabulated and organized by age, sex, social determinants, geography, and race/ethnicity to examine patterns of inequity. Relevant measures of association may be, for example, high-income vs low-income or urban vs rural residency. We will consider differences in health outcomes as health inequities if they are systematic, avoidable, unnecessary, unfair, and unjust [
Data from each identified study will be reported by type of digital intervention, which will follow the WHO classification. The WHO classification includes interventions for patients with HF (referred to as clients by the WHO), interventions for health care providers, interventions for health systems or service managers, and interventions for data services [
We will highlight areas where research is lacking or where findings are inconsistent. Stakeholder consultation will be integrated during interpretation of findings to validate relevance and identify gaps. This will involve engaging clinicians only, who will review preliminary findings and provide input on practical implications.
To contextualize our interpretation of inequities, we will include a structured appraisal of key methodological features using a checklist adapted from JBI guidance [
Study design
Sample size adequacy
Completeness of equity-related reporting (eg, socioeconomic status, geography, race/ethnicity)
Clarity of definitions for access and use
Findings from this appraisal will be summarized narratively to highlight major limitations and inform interpretation.