Equity-Oriented Design Processes and Evaluation of Digital Health Technologies for Black Communities Beyond Usability: Scoping Review.

Background: Black communities face disproportionate burdens of health disparities such as chronic disease, maternal morbidity, and barriers to accessing quality care. Digital health technologies (DHTs) are increasingly promoted as tools to reduce health disparities through access to care. However, the extent to which equity-oriented design approaches have been applied to address the needs of Black communities remains unclear. Objective: This scoping review aims to examine (1) current literature on DHTs designed to address health equity concerns among Black communities, (2) design approaches and evaluation mechanisms leveraged, and (3) the potential of the digital determinants of health (DDoH) framework to inform an equity evaluation of these tools. Methods: Guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), in April 2026, 3 online databases were searched (PubMed, Scopus, and Web of Science). Eligible studies were required to be published in English and report on the use of design approaches to develop DHTs for Black health equity concerns. Keywords related to digital health, equity, and design approaches were searched. No restrictions were placed on the publication date. Gray literature was searched using Google Scholar, and a reverse search was conducted through citation scanning. Identified studies were managed in Covidence with 2 independent reviewers. Data from included studies were extracted and mapped using tabular, graphical, and narrative synthesis. Results: Thirty-four studies were included in this review. Findings revealed a significant increase in publications over the past 5 years, with most studies conducted in the United States (25/34, 73.53%). HIV prevention or management was the most common health equity focus (9/34, 25.46%) with mobile apps as the primary technology (15/34, 44.12%). Most studies implemented a user-centered design (11/34, 32.35%) or a human-centered design (5/34, 14.71%) approach, while other studies used a combined or community-oriented approach. Two studies used an Afrofuturism approach to address broader dimensions of health equity, such as systemic racism and safety. Few studies explicitly evaluated digital health equity; assessments were typically limited to usability or feasibility (13/34, 38.24%). The application of the DDoH framework highlighted limited acknowledgment of determinants such as digital literacy, shared device privacy, and algorithmic bias. Conclusions: Despite the rise in the use of explicit design approaches to develop DHTs for Black communities, the application and evaluation of these approaches remain inconsistent. This review calls for more deliberate integration of equity metrics within the design process to ensure equitable design from start to finish. Leveraging frameworks such as the DDoH to conduct an equity analysis holds promise in assisting designers with keeping equity at the forefront of the design process. Through this work, 5 recommendations were proposed to standardize the design lifecycle to contribute to meaningful DHT design for the Black community.