Assessing Digital Health Underutilisation in Non-communicable Disease Care in Low- and Middle-Income Countries
- A multi-domain framework published in the journal Cureus identifies that digital health underutilisation in low- and middle-income countries (LMICs) persists due to barriers beyond simple access to technology.
- The study argues that the "digital divide" is often incorrectly defined as a lack of hardware or internet connectivity.
- This gap is particularly critical for NCDs, such as diabetes and hypertension, which require continuous monitoring and long-term care.
A multi-domain framework published in the journal Cureus identifies that digital health underutilisation in low- and middle-income countries (LMICs) persists due to barriers beyond simple access to technology. The research indicates that patient literacy, healthcare provider attitudes, and systemic infrastructure gaps prevent the effective use of digital tools for managing non-communicable diseases (NCDs).
The study argues that the “digital divide” is often incorrectly defined as a lack of hardware or internet connectivity. According to the Cureus report, many digital health interventions fail not because the technology is unavailable, but because it is underutilised by the people intended to use it.
This gap is particularly critical for NCDs, such as diabetes and hypertension, which require continuous monitoring and long-term care. The researchers propose a comprehensive framework to assess why these tools remain unused even when the physical infrastructure exists.
Why is digital health underutilised in LMICs?
The Cureus framework suggests that underutilisation happens when the deployment of technology ignores the social and systemic context of the healthcare environment. Access to a smartphone or a tablet does not automatically translate to clinical utility.
The researchers identify several intersecting domains that contribute to this failure. These include the technical skills of the patient, the willingness of the clinician to integrate digital tools into their workflow, and the reliability of the surrounding environment.
When one of these domains is neglected, the technology becomes “shelfware”—tools that are purchased and installed but never integrated into daily patient care.
What are the domains of the multi-domain framework?
The framework breaks down the barriers to digital health adoption into specific categories to help policymakers identify exactly where a system is failing. According to the study, these domains include:
How does this impact non-communicable disease care?
NCDs require a shift from episodic care to longitudinal management. Digital health tools, such as remote monitoring and mobile health (mHealth) apps, are designed to bridge the gap between clinic visits.
The Cureus research highlights that in LMICs, the burden of NCDs is rising rapidly. When digital tools are underutilised, patients miss critical windows for intervention, leading to higher rates of complications and mortality.
The study suggests that by applying the multi-domain framework, health systems can move from a “technology-first” approach to a “user-first” approach. This means assessing the digital literacy of the population and the readiness of the staff before deploying new software.
What are the consequences of ignoring these barriers?
Ignoring the non-technical barriers leads to wasted financial resources and skewed data. When only a small, tech-savvy portion of the population uses a digital health tool, the resulting data does not represent the broader patient population.
This creates a “secondary digital divide,” where the most vulnerable patients—those with the lowest literacy or the least stable electricity—are further marginalized from the healthcare system.
The researchers conclude that sustainable digital health integration requires a synchronized effort across all five domains. Improving connectivity (Environmental) will not work if the clinicians are not trained (Provider) or if the laws do not protect patient data (Policy).