DIGITAL HEALTH TRANSFORMATION AND UNIVERSAL HEALTHCARE ACCESS IN DEVELOPING COUNTRIES: A QUALITATIVE METASYNTHESIS
Keywords:
digital health, universal health coverage, developing countries, low- and middle-income countriesAbstract
Background. Universal health coverage (UHC) remains unevenly realized across developing countries, and digital health transformation is widely promoted as a lever for closing access gaps. Yet evidence on how and why digital transformation advances or obstructs equitable access is fragmented across heterogeneous qualitative studies, limiting cumulative understanding.
Objective. To interpretively integrate qualitative evidence on the relationship between digital health transformation and UHC access in low- and middle-income countries (LMICs), and to construct a higher-order explanatory model of the contextual mechanisms involved.
Methods. A qualitative metasynthesis was conducted following Noblit and Hare’s seven-phase meta-ethnography and reported against the ENTREQ statement. Six databases (Scopus, Web of Science, PubMed/MEDLINE, CINAHL, Embase, and Global Health) plus grey literature were searched for qualitative and mixed-methods studies (2014–2024). Eligibility was framed with SPIDER; selection followed PRISMA 2020 with dual independent screening; methodological quality was appraised with the CASP checklist. First- and second-order constructs were translated reciprocally and refutationally into third-order constructs and a line-of-argument synthesis.
Results. Twenty-two studies from 17 LMICs (n ≈ 642 participants) were synthesized. Six third-order constructs were generated: (1) the connectivity and energy substrate as a precondition; (2) digital literacy and the human interface; (3) governance, interoperability, and institutional embedding; (4) trust, confidentiality, and sociocultural fit; (5) financing, “pilotitis,” and the sustainability gap; and (6) the equity paradox of simultaneous bridging and widening of access. The line-of-argument synthesis frames digital health as a contingent amplifier: it magnifies existing health-system capacity and pre-existing inequities rather than acting as an autonomous equalizer.
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