JMIR Publications

ABSTRACT

Background:

The rapid virtualization of health services during COVID-19 is drawing increasing attention to the impact of virtual care technologies on health equity. In some circumstances, virtual care initiatives have been shown to increase health disparities, as individuals from underserved communities are less likely to benefit.

Objective:

The purpose of this paper is to describe a protocol for a scoping review of reviews that aims to map review-level evidence describing challenges and strategies for promoting effective engagement with virtual care technologies among underserved communities.

Methods:

Our methodology was adapted from seminal scoping review guidelines by Arksey and O’Malley, Levac at al., Colquhoun et al. and the Joanna Briggs Institute. Our search strategy was developed for the following databases: MEDLINE (on Ovid), EMBASE (on Ovid), CINAHL (on EBSCO), Scopus and Epistemonikos. Supplementary searches will include Google Scholar and reference tracking. Each citation will be independently screened by two researchers at the title and abstract level and full-text level according to our eligibility criteria. The eligibility criteria focus on the inclusion of methods-driven reviews (i.e., systematic reviews, scoping reviews, meta analyses, realist reviews and critical interpretative syntheses) to enhance rigour and quality. Other inclusion criteria include a focus on virtual care services that facilitate bi-directional patient-provider communication (video, telephone and asynchronous messaging visits) among populations identified as underserved (i.e., due to race, age, income and other factors related to the social determinants of health).

Results:

This scoping review of reviews will provide a broad overview of identified challenges associated with the accessibility of virtual healthcare services among underserved communities. In addition, strategies to improve access to, uptake of and engagement with virtual care technologies among underserved communities will be identified. Knowledge synthesized from this review will aid in developing and implementing virtual services that acknowledge the unique needs of populations who experience barriers to care and disproportionately worse health outcomes. The results will also inform gaps in current research.

Conclusions:

The rapid shift towards virtual health services calls for an urgent need to critically examine the intersection of virtual care and health equity. While technology-driven innovations in healthcare generally aim to improve access, quality and health outcomes, it is also possible for these tools to produce intervention-generated inequities. Assessing current review-level evidence on the key challenges and strategies to improve the application of virtual care among underserved communities is imperative to ensure they benefit all populations.