Digital determinants of health: a systematic scoping review of existing conceptual frameworks

Background

Digital transformation is reshaping healthcare worldwide, with potential to reduce or reinforce inequalities. The concept of Digital Determinants of Health (DDoH) has emerged to describe factors rooted in or linked to the digital world that directly or indirectly influence health. Yet, conceptual approaches remain heterogeneous and lack operationalisation. This study aimed to identify and analyse existing frameworks on DDoH in order to map their definitions, scope, and key components, and to highlight areas of convergence, divergence, and conceptual gaps.

Methods

A systematic scoping review was conducted following PRISMA-SCr. Six databases were searched (June–July 2025) for studies published between 2015-2025 presenting conceptual models or frameworks addressing DDoH. Extracted data included framework definitions, dimensions, levels of analysis, key concepts and gaps.

Results

17 frameworks were included. All recognised that DDoH shape health and interact with established social determinants of health, often positioning DDoH as cross-cutting influences across levels. Most frameworks adopted multi-level perspectives and highlighted interactions between these layers. However, there was marked heterogeneity in how DDoH were defined and the criteria to select them. Only a minority proposed specific indicators, measurement strategies or detailed guidance for applying the frameworks in practice. Most frameworks originated in high-income countries and were developed by teams based in a limited range of disciplines, with scarce representation from low- and middle-income settings.

Conclusions

The field of DDoH is expanding but remains conceptually fragmented. Lack of standardisation and operational clarity hampers their use in monitoring and policy. Greater conceptual alignment and broader global representation are needed to embed DDoH more firmly into public health research and practice.

Key messages

• Existing DDoH frameworks agree that digital factors shape health across multiple levels and interact with social determinants, but their definitions and selection criteria remain highly heterogeneous.

• Few DDoH frameworks offer concrete indicators or implementation guidance, and most come from high‑income settings, which may limit their usefulness for equity‑oriented public health practice globally.