Assessing the Digital Advancement of Public Health Systems Using Indicators Published in Gray Literature: Narrative Review

• Published in: JMIR public health and surveillance 2024-11, Vol.10, p.e63031
• Main Authors: Maaß, Laura, Badino, Manuel, Iyamu, Ihoghosa, Holl, Felix
• Format: Article
• Language: English
• Subjects: Artificial intelligence; Delphi method; Digital Health; Digital literacy; Digital technology; Global health; Grey literature; Health care; Health care delivery; Health literacy; Health promotion; Health services; Humans; Infrastructure; International organizations; Maturity; Objectives; Public health; Public Health - methods; Review; Search strategies
• ISSN: 2369-2960; 2369-2960
• DOI: 10.2196/63031

Revealing the full potential of digital public health (DiPH) systems requires a wide-ranging tool to assess their maturity and readiness for emerging technologies. Although a variety of indices exist to assess digital health systems, questions arise about the inclusion of indicators of information and communications technology maturity and readiness, digital (health) literacy, and interest in DiPH tools by the society and workforce, as well as the maturity of the legal framework and the readiness of digitalized health systems. Existing tools frequently target one of these domains while overlooking the others. In addition, no review has yet holistically investigated the available national DiPH system maturity and readiness indicators using a multidisciplinary lens. We used a narrative review to map the landscape of DiPH system maturity and readiness indicators published in the gray literature. As original indicators were not published in scientific databases, we applied predefined search strings to the DuckDuckGo and Google search engines for 11 countries from all continents that had reached level 4 of 5 in the latest Global Digital Health Monitor evaluation. In addition, we searched the literature published by 19 international organizations for maturity and readiness indicators concerning DiPH. Of the 1484 identified references, 137 were included, and they yielded 15,806 indicators. We deemed 286 indicators from 90 references relevant for DiPH system maturity and readiness assessments. The majority of these indicators (133/286, 46.5%) had legal relevance (targeting big data and artificial intelligence regulation, cybersecurity, national DiPH strategies, or health data governance), and the smallest number of indicators (37/286, 12.9%) were related to social domains (focusing on internet use and access, digital literacy and digital health literacy, or the use of DiPH tools, smartphones, and computers). Another 14.3% (41/286) of indicators analyzed the information and communications technology infrastructure (such as workforce, electricity, internet, and smartphone availability or interoperability standards). The remaining 26.2% (75/286) of indicators described the degree to which DiPH was applied (including health data architecture, storage, and access; the implementation of DiPH interventions; or the existence of interventions promoting health literacy and digital inclusion). Our work is the first to conduct a multidisciplinary analysis of the gray literatu