{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:09:26Z","timestamp":1784851766052,"version":"3.55.0"},"reference-count":53,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["DIGITAL HEALTH"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Digital health technologies (DHTs) are recognized by the World Health Organization (WHO) as essential to achieving Universal Health Coverage, yet major equity gaps persist in low-resource settings such as Ethiopia. This scoping review applies the PROGRESS-Plus framework to examine how overlapping social identities (e.g., gender, residence, and income) shape inequities in access to, use of, and engagement with DHTs in Ethiopia's primary healthcare (PHC) system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following Arksey and O'Malley's framework enhanced by Levac et al. and reported using PRISMA-ScR 2020 guidelines. Searches were conducted in PubMed, Scopus, Web of Science, EMBASE, Google Scholar, and grey-literature sources for studies published between 2015 and 2025. Eligibility criteria were guided by the PCC framework, focusing on digital health interventions (DHIs) within Ethiopia's PHC system with explicit equity relevance. Data were extracted, charted, and synthesized using the PROGRESS-Plus framework, supported by thematic analysis, descriptive statistics, and integration with the WHO digital health intervention taxonomy and the NASSS implementation framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-one studies met inclusion criteria. Digital health inequities consistently clustered around residence, education, socioeconomic status, gender, occupation, and marginalized-group status. Structural barriers, poor connectivity, limited devices, and inadequate digital health skills, disproportionately affected rural and pastoralist communities. Advanced digital health tools (AI, telemedicine, EMRs) were largely restricted to urban and better-resourced settings. Engagement was shaped by cultural and linguistic relevance, trust, peer support, and institutional readiness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Digital transformation in Ethiopia's PHC system remains constrained by intersecting social determinants. Applying PROGRESS-Plus demonstrates that technological expansion alone cannot ensure equitable uptake. Equity-centered digital strategies, emphasizing infrastructure, contextualized design, capacity building, and inclusive governance, are essential for meaningful and sustainable digital health transformation adoption across all populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20552076251408535","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T18:28:18Z","timestamp":1765996098000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Mapping inequities in digital health transformation within Ethiopia's primary health care system using PROGRESS-plus: Scoping review"],"prefix":"10.1177","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6318-4092","authenticated-orcid":false,"given":"Ibsa","family":"Mussa","sequence":"first","affiliation":[{"name":"Haramaya University"},{"name":"University of South Africa, Pretoria, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabelani","family":"Dagada","sequence":"additional","affiliation":[{"name":"University of South Africa, Pretoria, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"World Health Organization. Global health observatory data repository. Geneva: World Health Organization 2023."},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.2196\/40721"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1089\/tmr.2020.0002"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.942703"},{"key":"e_1_3_3_6_2","volume-title":"Digital health in Ethiopia: Landscape assessment and lessons from COVID-19 response","author":"UNICEF","year":"2022","unstructured":"UNICEF. Digital health in Ethiopia: Landscape assessment and lessons from COVID-19 response. Addis Ababa: UNICEF Ethiopia, 2022."},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1080\/1364557032000119616"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-5-69"},{"key":"e_1_3_3_9_2","volume-title":"Rapid reviews to strengthen health policy and systems: a practical guide","author":"Tricco AC","year":"2017","unstructured":"Tricco AC, Langlois EV, Straus SE. Rapid reviews to strengthen health policy and systems: a practical guide. Geneva: World Health Organization, 2017."},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.19.248328"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/9781119536604.ch4"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.11124\/JBIES-20-00167"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mex.2021.101375"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.2196\/44181"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.glmedi.2024.100171"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.8775"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-025-12282-y"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdy199"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0003628"},{"key":"e_1_3_3_20_2","volume-title":"The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses","author":"Peterson J","year":"2011","unstructured":"Peterson J, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute, 2011."},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.3233\/EFI-180221"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552076241261930"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2022.935945"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552076221131144"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/1460458220911779"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1186\/1478-4491-13-2"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.900293"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-021-00487-4"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdy199"},{"key":"e_1_3_3_30_2","first-page":"2023","article-title":"Barriers, facilitators and motivators of electronic community health information system use among health workers in Ethiopia","volume":"5","author":"Bogale TN","year":"2023","unstructured":"Bogale TN, Teklehaimanot SM, Fufa Debela T, et al. Barriers, facilitators and motivators of electronic community health information system use among health workers in Ethiopia. Front Dig Health 2023; 5: 2023.","journal-title":"Front Dig Health"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552076241261930"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-023-09629-8"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0322460"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1130894"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1097\/j.jcrs.0000000000000407"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pdig.0000587"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13690-025-01641-0"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.965524"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552076231180436"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.4103\/ijmy.ijmy_235_21"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-023-02385-z"},{"key":"e_1_3_3_42_2","volume-title":"National eHealth Strategy 2022\u20132026","author":"Ministry of Health","year":"2022","unstructured":"Ministry of Health. National eHealth Strategy 2022\u20132026. Kigali, Rwanda, 2022."},{"key":"e_1_3_3_43_2","volume-title":"Global strategy on digital health 2020\u20132025","author":"World Health Organization.","year":"2021","unstructured":"World Health Organization. Global strategy on digital health 2020\u20132025. Geneva: World Health Organization, 2021."},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.2147\/JMDH.S284973"},{"key":"e_1_3_3_45_2","unstructured":"World Bank. Ethiopia digital economy diagnostic report. 2022."},{"key":"e_1_3_3_46_2","unstructured":"Federal Ministry of Health and Ethiopia Public Health Institute. eCHIS Implementation Manual Draft 2. Addis Ababa Ethiopia 2023."},{"key":"e_1_3_3_47_2","volume-title":"Digital Health Scale-Up Framework offers actionable strategies, such as public-private partnerships and DHIS2 integration","author":"World Health Organization","year":"2023","unstructured":"World Health Organization. Digital Health Scale-Up Framework offers actionable strategies, such as public-private partnerships and DHIS2 integration. Geneva: World Health Organization Press, 2023."},{"key":"e_1_3_3_48_2","volume-title":"National Digital Health Blueprint","author":"MoHFW India","year":"2020","unstructured":"MoHFW India. National Digital Health Blueprint. New Delhi: Ministry of Health and Family Welfare, 2020."},{"key":"e_1_3_3_49_2","volume-title":"Digital Health Blueprint 2021-2030","author":"World Health Organization","year":"2021","unstructured":"World Health Organization. Digital Health Blueprint 2021-2030. Addis Ababa, Ethiopia: Ministry of Health, 2021."},{"key":"e_1_3_3_50_2","volume-title":"Ethiopia Health Sector Transformation Plan","author":"Federal Ministry of Health","year":"2023","unstructured":"Federal Ministry of Health. Ethiopia Health Sector Transformation Plan. Addis Ababa, Ethiopia: Ministry of Health, 2023."},{"key":"e_1_3_3_51_2","volume-title":"Digital Health in Ethiopia: Landscape Assessment and Lessons from COVID-19 Response","author":"UNICEF","year":"2022","unstructured":"UNICEF. Digital Health in Ethiopia: Landscape Assessment and Lessons from COVID-19 Response. Addis Ababa: UNICEF Ethiopia, 2022."},{"key":"e_1_3_3_52_2","volume-title":"Information Revolution Strategic Plan: 2018-2025","author":"Federal Ministry of Health","year":"2018","unstructured":"Federal Ministry of Health. Information Revolution Strategic Plan: 2018-2025. Addis Ababa, Ethiopia: Ministry of Health, 2018."},{"key":"e_1_3_3_53_2","volume-title":"Health Sector Performance Report 2022\/2023","author":"Federal Ministry of Health","year":"2023","unstructured":"Federal Ministry of Health. Health Sector Performance Report 2022\/2023. Addis Ababa: Federal Ministry of Health, 2023."},{"key":"e_1_3_3_54_2","volume-title":"National eHealth Strategy 2022\u20132026","author":"Ministry of Health","year":"2022","unstructured":"Ministry of Health. National eHealth Strategy 2022\u20132026. Kigali, Rwanda, 2022."}],"container-title":["DIGITAL HEALTH"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552076251408535","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20552076251408535","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552076251408535","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:55:29Z","timestamp":1777398929000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20552076251408535"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":53,"alternative-id":["10.1177\/20552076251408535"],"URL":"https:\/\/doi.org\/10.1177\/20552076251408535","relation":{},"ISSN":["2055-2076","2055-2076"],"issn-type":[{"value":"2055-2076","type":"print"},{"value":"2055-2076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5]]},"article-number":"20552076251408535"}}