The researchers focused on Social and Digital Determinants of Health, or SD-DOH. Traditional social determinants include housing stability, food access, transportation, employment, education, neighborhood safety, and social connection. Digital determinants add another layer, including internet availability, device ownership, digital literacy, access to telehealth, the usability of online patient portals, and the ability to navigate increasingly technology-dependent health systems. These factors can determine whether a patient receives an appointment reminder, completes a telemedicine visit, finds trustworthy health information, or remains connected to clinicians after leaving a hospital. As healthcare rapidly adopts artificial intelligence, remote monitoring, online scheduling, and virtual care, unequal digital access can amplify existing racial, geographic, economic, and age-related disparities.

To investigate how organizations respond, the team conducted a PRISMA-ScR-guided scoping review and qualitative evidence synthesis. The researchers searched PubMed, Scopus, ProQuest, and CINAHL for U.S.-based peer-reviewed and gray literature published from January 2020 through June 2025. They identified 94 sources that described the perspectives of healthcare leaders or other organizational stakeholders on responsibility for addressing SD-DOH. Rather than treating responsibility as a single activity, the researchers analyzed the literature through two complementary frameworks: four strategic levers used by health systems and an expanded version of the National Academy of Medicine’s five-part social care framework.

The four strategic levers represent different levels of intervention. Enabling services are downstream activities delivered directly to patients, such as screening for social needs, providing transportation assistance, connecting people with food resources, or supporting digital access. Community partnerships operate at a midstream level, linking hospitals with community-based organizations, schools, local agencies, and public health departments. Policy advocacy is an upstream strategy that seeks to influence laws, regulations, reimbursement systems, and public investment. Direct community investment is another upstream approach, in which healthcare organizations commit financial resources, infrastructure, or institutional assets to address the conditions producing poor health. Together, these categories allowed the researchers to distinguish between helping individuals navigate existing barriers and attempting to reduce or remove the barriers themselves.

The second framework describes how organizations conceptualize their responsibilities. Awareness involves identifying patients’ social and digital needs, often through screening, electronic health record documentation, or community health assessments. Assistance means connecting individuals with services or resources. Adjustment refers to modifying clinical practices, communication, or care delivery to accommodate patients’ circumstances. Alignment involves coordinating healthcare organizations with community partners and broader systems. Advocacy describes efforts to influence public policy and structural conditions. The researchers added a sixth category—system governance and accountability—to capture leadership structures, performance measurement, institutional oversight, and mechanisms that make equity an organizational obligation rather than an optional project.

The results reveal a clear imbalance in the current landscape. Enabling services appeared in 86% of the initiatives identified in the literature, making them by far the most common form of equity-oriented action. Community partnerships followed at 70%. By comparison, policy advocacy appeared in 34% of initiatives, while direct community investment was present in only 9%. The pattern suggests that many health systems are willing to help patients manage immediate obstacles, but far fewer are consistently investing in or challenging the systems that create those obstacles. In practical terms, a hospital may help a patient arrange transportation or enroll in a food program, yet stop short of using its political influence or financial resources to address inadequate transit, food insecurity, broadband gaps, or unstable housing at their source.

The responsibility perspectives found in the literature were also multidimensional. Alignment was the most frequently observed perspective, appearing in 83% of the sources or initiatives analyzed. Assistance appeared in 68%, Adjustment in 65%, Awareness in 61%, and system governance and accountability in 60%. Advocacy was least common, appearing in 32%. This ordering suggests that healthcare leaders often see collaboration and coordination as central responsibilities, while direct political engagement remains more difficult to institutionalize. Alignment may include formal partnerships with community-based organizations, referral networks, shared care plans, joint health assessments, and coordinated responses to local needs. However, collaboration alone does not necessarily redistribute power or funding, and the review indicates that partnerships are most effective when supported by governance systems that clarify roles, measure outcomes, and sustain accountability.

The strongest connections between responsibility perspectives and strategic action appeared where organizations were closest to patient care. Assistance and Adjustment were each associated with 98% of enabling-service initiatives, showing that direct support and flexible care delivery tend to develop together. Alignment appeared in every community-partnership initiative and every direct-community-investment initiative, as well as in 83% of enabling-service initiatives. The relationship between Advocacy and upstream work was especially pronounced: Advocacy appeared in 88% of direct-community-investment initiatives, but in only 25% of enabling-service initiatives. System governance and accountability acted as a bridge across all four levers, appearing in 100% of direct-community-investment initiatives, 75% of policy-advocacy initiatives, 56% of community partnerships, and 54% of enabling-service initiatives.

The authors interpret these findings as evidence that U.S. health systems may be approaching an inflection point. Governance and accountability are already present in a substantial share of initiatives, meaning that organizations may possess some of the institutional tools needed to move beyond isolated programs. Those tools can include executive oversight, equity metrics, board-level reporting, community benefit requirements, dedicated budgets, workforce training, and integration of social and digital needs into electronic health records and quality-improvement systems. The challenge is converting recognition into durable organizational behavior. If equity goals are not linked to funding, leadership evaluation, clinical performance measures, and transparent reporting, they can remain vulnerable to changing priorities and short-term grants.

The review also suggests that policy advocacy may be a realistic next step for organizations that have already developed strong partnerships and internal alignment. Healthcare systems are among the largest employers and economic institutions in many communities, giving them potential influence over broadband expansion, housing policy, transportation, food access, Medicaid reimbursement, digital inclusion, and public health funding. Yet the researchers caution, implicitly through the evidence, that upstream responsibility should not replace direct services. Patients facing immediate needs still require practical assistance, while long-term improvements demand coordinated action across healthcare, government, business, education, and community organizations. The emerging model is therefore not a choice between treating individuals and changing systems, but a progression in which patient support, community alignment, governance, investment, and advocacy reinforce one another. As healthcare becomes more digital and health inequities remain deeply connected to social conditions, the study argues that responsibility for health can no longer be limited to what happens inside the examination room.

Subject of Research: Healthcare responsibility for addressing social and digital determinants of health in the United States

Article Title: Leader and organizational stakeholder perspectives on healthcare responsibility for addressing Social and Digital Determinants of Health (SD-DOH) in the United States: a scoping review and qualitative evidence synthesis

Article References: Rangachari, P., Thapa, A., Gari, S. N. B., et al. “Leader and organizational stakeholder perspectives on healthcare responsibility for addressing Social and Digital Determinants of Health (SD-DOH) in the United States: a scoping review and qualitative evidence synthesis.” BMC Public Health (2026).

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29142-x

Keywords: Social determinants of health; Social and digital determinants of health; Health system responsibility; Equity-oriented initiatives; Digital equity; Cross-sector collaboration; Shared accountability; Policy advocacy

The advent of DHT has brought to light pressing issues related to access, including well-studied social determinants such as income, education, and geographic location, which have consistently been identified as barriers to healthcare equity. Intersecting with these social factors are the digital determinants of health, including digital literacy, which plays a key role in a person’s ability to engage with technology effectively. Moreover, the adequacy and availability of digital infrastructure—high-speed internet connections and reliable devices—are often lacking, further supporting the divide seen across different communities. Without addressing both social and digital determinants, achieving a truly inclusive healthcare environment remains an uphill battle.

Companies driving innovation in DHT must recognize that access disparities present a critical obstacle to the tools they create. Vulnerable groups—who would benefit immensely from digital interventions—often find themselves on the fringes of technology adoption. Encounters with digital health tools can be daunting when foundational digital literacy is absent. Furthermore, these communities might not have access to consistent guidance and support, resulting in their further alienation from those who could benefit from DHT the most.

In addressing these barriers, it is essential to adopt a personalized framework that caters to diverse patients and communities. Acknowledging the multi-layered nature of health access issues requires a comprehensive approach that considers individual needs alongside broader socio-economic contexts. This approach highlights the importance of collaborative engagement across multiple societal actors including governmental agencies, healthcare providers, and technology developers. By fostering cooperation at all levels, we can expand the reach of DHT and ensure that its benefits permeate through all societal strata.

There’s a pressing need for research aimed at understanding how varied determinants impact access to DHT. By gathering data on and insights from diverse patient populations, healthcare providers are empowered to construct tailored interventions that meet patients’ unique needs. The aim is not just to bridge the gap in access but also to build a robust evidence base that properly reflects the experiences and realities shared across different demographic groups. Avoiding the perpetuation of historical biases should inform the ways in which DHT develops and matures.

Globally, the accessibility challenges associated with DHT are neither uniform nor straightforward. They vary significantly across continents due to contextual factors such as healthcare systems, governmental policies, and technological infrastructure. By framing these challenges on a global scale, we can identify shared themes that resonate across populations while also acknowledging unique regional needs and solutions. Such a global perspective fosters learning and syndicates best practices that can be tailored for local implementation.

Perspectives from diverse stakeholders—including clinicians, researchers, industry experts, and the communities served—are invaluable in shaping a nuanced understanding of DHT deployment and its reception. Each stakeholder provides essential viewpoints that illuminate different aspects of digital health technology access, revealing invaluable insights into the barriers faced. Collaboratively, they can formulate comprehensive strategies that encourage acceptance and usage of technology among skeptical and underrepresented groups.

Going forth, the partnership between healthcare providers, industry leaders, and policy makers will be pivotal. There is an imperative need for a concerted effort to ensure regulations and systems are designed to promote equitable access. Investment in public health initiatives that enhance digital literacy and expand technological infrastructure will be critical for creating an environment where DHT can thrive and be accessible to all.

In conclusion, while the potential of digital health technologies to transform health care is vast and multifaceted, unlocking their full capacity requires intentional efforts to address the disparities in access that persist. A thorough and collaborative approach—one that welcomes diverse voices and prioritizes equity—will ensure that the future of digital health benefits everyone, regardless of their background. This will not only enhance health outcomes but also fortify the foundation for a more inclusive healthcare landscape where all individuals can realize their full health potential through technology.

The time to act is now, as the rapid evolution of healthcare digitalization moves forward with unprecedented speed. Preparing for an equitable future means making strategic decisions today that acknowledge and combat the barriers that currently exist. By doing so, we will not only pioneer advancements in medical technology but also ensure that these advancements are universally accessible and beneficial to all, fostering a healthier planet in the process.

Subject of Research: Access to Digital Health Technologies

Article Title: Access to digital health technologies: personalized framework and global perspectives.

Article References:

Narayan, S.M., Chung, M.K., Adedinsewo, D. et al. Access to digital health technologies: personalized framework and global perspectives.
Nat Rev Cardiol (2025). https://doi.org/10.1038/s41569-025-01184-5

Image Credits: AI Generated

DOI: 10.1038/s41569-025-01184-5

Keywords: Digital Health Technologies, Health Disparities, Social Determinants, Digital Literacy, Healthcare Access, Global Health.