Challenges and Strategies for Promoting Health Equity in Virtual Care: Protocol for a Scoping Review of Reviews

Jamie Keiko Fujioka; Suman Budhwani; Tyla Thomas-Jacques; Kristina De Vera; Priyanka Challa; Kaitlin Fuller; Sophie Hogeveen; Dara Gordon; Simone Shahid; Emily Seto; James Shaw

doi:10.2196/22847

Challenges and Strategies for Promoting Health Equity in Virtual Care: Protocol for a Scoping Review of Reviews

JMIR Res Protoc. 2020 Dec 7;9(12):e22847. doi: 10.2196/22847.

Authors

Affiliations

¹ Women's College Hospital, Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.
² Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
³ University of Toronto Libraries, University of Toronto, Toronto, ON, Canada.
⁴ Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada.
⁵ Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada.

PMID: 33211020
PMCID: PMC7721627
DOI: 10.2196/22847

Abstract

Background: The rapid virtualization of health services during the COVID-19 pandemic has drawn increasing attention to the impact of virtual care technologies on health equity. In some circumstances, virtual care initiatives have been shown to increase health disparities, as individuals from underserved communities are less likely to benefit from such initiatives.

Objective: The purpose of this paper is to describe a protocol for a scoping review of reviews that aims to map review-level evidence that describes challenges and strategies for promoting effective engagement with virtual care technologies among underserved communities.

Methods: Our methodology was adapted from seminal scoping review guidelines provided by Arksey and O'Malley, Levac at al, Colquhoun et al, and the Joanna Briggs Institute. Our search strategy was developed for the following databases: MEDLINE (on Ovid), EMBASE (on Ovid), CINAHL (on EBSCO), Scopus, and Epistemonikos. Supplementary searches will include the use of Google Scholar and reference tracking. Each citation will be independently screened by 2 researchers at the title and abstract level, and full-text screening will be performed in accordance with our eligibility criteria. The eligibility criteria focused on the inclusion of methods-driven reviews (ie, systematic reviews, scoping reviews, meta-analyses, realist reviews, and critical interpretative syntheses) to enhance rigor and quality. Other inclusion criteria included a focus on virtual care services that facilitate bidirectional patient-provider communication (ie, video, telephone, and asynchronous messaging visits) for underserved populations (ie, those who experience social disadvantage due to race, age, income, and other factors related to the social determinants of health).

Results: This scoping review of reviews will provide a broad overview of identified challenges associated with the accessibility of virtual health care services among underserved communities. In addition, strategies for improving the access to, uptake of, and engagement with virtual care technologies among underserved communities will be identified. The knowledge synthesized from this review will aid in developing and implementing virtual services that acknowledge the unique needs of populations who experience barriers to care and disproportionately worse health outcomes. The results will also inform gaps in current research.

Conclusions: The rapid shift toward virtual health services has highlighted the urgent need to critically examine the intersection of virtual care and health equity. Although technology-driven innovations in health care generally aim to improve access, quality, and health outcomes, it is also possible for these innovations to produce intervention-generated inequities. Assessing current review-level evidence on the key challenges and strategies for improving the application of virtual care in underserved communities is imperative for ensuring that virtual care benefits all populations.

International registered report identifier (irrid): PRR1-10.2196/22847.

Keywords: COVID-19; challenge; digital health; health equity; scoping review; strategy; telemedicine; virtual care.

©Jamie Keiko Fujioka, Suman Budhwani, Tyla Thomas-Jacques, Kristina De Vera, Priyanka Challa, Kaitlin Fuller, Sophie Hogeveen, Dara Gordon, Simone Shahid, Emily Seto, James Shaw. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 07.12.2020.