Creating a Basic Ethical Framework for Digital Lifestyle Interventions: A Narrative Review.

Digital tools are often seen as promising avenues for promoting and sustaining healthy lifestyle behaviors. They not only offer benefits such as personalization, scalability, and cost-effectiveness but also raise significant ethical concerns. Issues such as equitable access, informed consent, and fair outcomes, particularly for vulnerable populations, must be addressed. An ethical framework is needed to guide the creation of digital lifestyle interventions. A narrative review was conducted across 3 domains: (1) general ethical principles for public health interventions, (2) ethical frameworks for lifestyle interventions, and (3) ethical considerations for digital tools in health promotion. A total of 16 articles were found across all 3 inclusion domains. The following 5 core ethical themes were identified: (1) respect for autonomy; (2) beneficence; (3) harms; (4) equity; and (5) responsibility, sustainability, and accountability. Two ethical considerations stood out in the context of digital interventions: health equity and privacy. Although digital tools may be an effective form of lifestyle intervention, they can disproportionately benefit individuals already in advantaged positions. We present a basic ethical framework for guiding the development and deployment of these digital tools. The framework highlights the tensions that may arise between competing ethical principles and helps developers determine which considerations are most relevant, and to whom, at different stages of intervention design and development.