Understanding digital inclusion through the transformation of services and users: a narrative review and novel framework.

The move towards digitally enabled healthcare offers the opportunity to deliver better care for all. Despite this potential, existing evidence suggests the same widely reported health inequalities that currently impact underserved populations are retained and often exacerbated by digital health services. In an attempt to overcome this digital divide, the related concept of digital inclusion has emerged that describes the policies, commissioning, and service-level actions and interventions necessary to address the issue. However, existing frameworks which have attempted to describe and understand digital inclusion have failed to reflect the evolution of organisations, services and users over time. Understanding inclusivity through the lens of digital transformation offers one way of providing a more accurate reflection of how contextual influences on digital inclusion relating to users, organisational processes and broader policy level interventions evolve temporally. The work presented here describes a novel framework for digital inclusion that combines the recognised elements of the digital divide with the core principles of digital transformation. The framework provides a multilevel understanding of how policy, organisations, communities and individuals combine and interact over time and successfully provides a unified means of developing and delivering more holistic strategies better equipped to address sustained digital inclusion. The framework is supported by a structured narrative review that provides exemplar evidence that underpins its constructs and theoretical position.