Understanding digital health ecosystem from Australian citizens’ perspective: A scoping review

Background
Digital health (DH) and the benefits of related services are fairly well understood. However, it still is critical to map the digital health care landscape including the key elements that define it as an ecosystem. Particularly, knowing the perspectives of citizens on this digital transformation is an important angle to capture. In this review we aim to analyze the relevant studies to identify how DH is understood and experienced by Australian citizens and what they may require from DH platforms.

Materials and methods
A scoping literature review was conducted across several electronic databases (ACM Digital Library, OVID, PubMed, Scopus, IEEE, Science Direct, SAGE), as well as grey literature. Additionally, citation mining was conducted to identify further relevant studies. Identified studies were subjected to eligibility criteria and the final set of articles was independently reviewed, analyzed, discussed and interpreted by three reviewers.

Results
Of 3811 articles, 98 articles met the inclusion criteria with research-based articles–as opposed to review articles or white papers– comprising the largest proportion (72%) of the selected literature. The qualitative analysis of the literature revealed five key elements that capture the essence of the digital health ecosystem interventions from the viewpoint of the Australian citizens. The identified elements were “consumer/user”, “health care”, “technology”, “use and usability”, “data and information”. These elements were further found to be associated with 127 subcategories.

Conclusions
This study is the first of its kind to analyze and synthesize the relevant literature on DH ecosystems from the citizens’ perspective. Through the lens of two research questions, this study defines the key components that were found crucial to understanding citizens’ experiences with DH. This understanding lays a strong foundation for designing and fostering DH ecosystem. The results provide a solid ground for empirical testing.