Digital determinants of health and their impact in strategic planning: a delphi study in Catalonia

Background

Digital transformation is reshaping health systems. While digital technologies may improve access and efficiency, they can also exacerbate inequalities. Digital determinants of health are factors rooted in or inextricably linked to the digital world that directly or indirectly influence health and well-being, altering care delivery and creating or reshaping pathways affecting population health. However, global frameworks have rarely been translated into regional planning. This study aimed to identify which determinants are prioritised for strategic health planning in Catalonia and assess their equity implications.

Methods

A modified Delphi study was conducted with experts from Catalonia’s health and digital ecosystem. The initial set comprised 127 determinants identified in a global prioritisation exercise, including emerging digital determinants and pre-existing determinants reshaped by digitalisation. Experts in digital health, public health, healthcare delivery and equity rated determinants on a 5-point Likert scale over two rounds, followed by an online consensus meeting. Median scores, interquartile ranges and proportion of ratings ≥4 were used to classify determinants by relevance.

Results

Forty-three experts participated in round one and 31 in round two. Of 127 determinants, 20 (15.7%) were classified as highly relevant for Catalonia, including 15 digital, 4 social and 1 political determinant. Priorities focused on enabling equitable digital health use, particularly access, digital skills, system-level capacity and governance, inclusive design and responsible AI. Comparison with the global Delphi showed overlap but also context-specific priorities.

Conclusions

Digital transformation must be addressed as a multi-level governance and equity issue rather than solely technological expansion. Context-specific prioritisation can inform regional planning, strengthen digital governance and support equity-sensitive implementation in European health systems.

Key messages

• In Catalonia, the Delphi identified 20 priority health determinants for planning, 15 of them digital, highlighting the strategic role of digital factors in health systems.

• In digitally mature settings, planning should move beyond technology adoption and prioritise equity, governance, interoperability, inclusive design and responsible AI use.