Over the past decade, digital health has become an essential pillar of any healthcare delivery model that aims to be sustainable and citizen-oriented (World Health Organization, 2021). In this field, the use of digital technologies complements healthcare by enabling a communicational and informational bridge between health services and the person’s home, fostering the individual's active role in health promotion and disease management (DGS, n.d.).
Nevertheless, it is important to remember that involvement in health and care decision-making should be voluntary, not mandatory. It must respect the person’s ability to transition from a paternalistic model of care to one that is integrated, participatory, and personalized—promoting greater collaboration among the various actors involved in therapeutic and supportive relationships (Sharon, 2017).
The SARS-CoV-2 pandemic reinforced the need for such care models, highlighting concerns related to ensuring confidentiality and quality of care (O'Neill et al., 2022), and stimulating discussion around potential solutions to make remote care a safer practice (Neeman et al., 2021).
Clearly, the use of telehealth involves more than just technological infrastructure. The organizational structure, clinical workflows, the multidisciplinary health team, the user and their family must all be considered and involved—both in identifying barriers and in defining strategies to enable equitable access to telehealth (Heyer et al., 2021; Zimmerman et al., 2020). Therefore, in promoting digital health and the adoption of telehealth, it is crucial to understand the needs, requirements, and perspectives of end users (i.e., healthcare professionals, service managers, and patients) within the specific care contexts in which it will be implemented (Spelten et al., 2021). This brings forth the need to uphold person-centeredness as a foundational condition for equitable digital health.
Grounded in Paul Ricoeur’s ethics of “living the good life, with and for others, in just institutions” (1992, p. 172), the principles of person-centeredness are realized in the health professional’s moral and ethical duty to assist and support the person beyond their illness. The person is a unique being, with their own values and preferences—capable and responsible, despite any fragility illness may bring. As such, the person is as much an expert in their life situation and health/disease experience as the healthcare professional is in the health sciences and care (Britten et al., 2020).
Healthcare delivery thus occurs through an expert partnership (i.e., healthcare professional–patient), where the symmetry of knowledge and power leads to the co-creation of a health plan grounded in shared decision-making and jointly defined goals (Ekman et al., 2011).
Additionally, this approach respects and promotes users' rights to equitable access to resources that support the achievement of their life goals, reinforce their capacities, and assist in coping with and managing vulnerabilities (Ekman, 2022).
As part of a person-centered and integrated healthcare system, digital health must naturally be informed by person-centered principles, which are the same principles that underlie theoretical models of person-centered practice, so that it can be co-designed and used equitably. Equitable digital health, beyond addressing access and use of digital technologies, mediated by digital literacy and motivation, must be grounded in integrated and person-centered care practices. These practices require a commitment from the healthcare system, an organizational mission, and services that operate based on the ethical principles of person-centeredness at all institutional levels.
These ethical principles call for an ambitious vision of well-being in interdependence—a vision that goes philosophically beyond individuality, proximity, and engagement (Bobrowicz-Campos & Ventura, 2022).
In the context of digital equity, three essential conditions are necessary to ensure the fair distribution of benefits from digital transformation: (i) access to digital infrastructures and connectivity, (ii) digital literacy for responsible and informed technology use, and (iii) motivation for widespread engagement with digital tools. The SARS-CoV-2 pandemic underscored the importance of these conditions, exposing inequalities that hinder trust, safety, and the perceived value of digital technologies, particularly in healthcare.
As digital health becomes a vital complement to healthcare systems seeking proximity to citizens, it is crucial to understand how its universalization addresses individual health needs and fosters effective therapeutic relationships. The Person-Centered Care model, grounded in Ricœur’s ethics of “living the good life, with and for others, in just institutions,” offers an innovative approach to sustainability, patient satisfaction, and equitable access.
Anchored in the principles of digital equity and person-centered care, this study aims to assess the adequacy of a theoretical model of equitable digital health from the perspectives of healthcare users, professionals, and service managers.
This study aims to evaluate the relevance and adequacy of a theoretical model for equitable digital health, guided by the principles of digital equity and person-centered care. The specific objectives are:
A mixed-methods study with a convergent parallel design will be employed, with data collection and analysis occurring simultaneously and interactively.
The transition to a digital society, driven by technological innovation, is reshaping the organization and delivery of healthcare services. This transformation enhances their efficiency and alignment with citizens’ needs, yielding social, economic, and cultural benefits.
To promote equitable digital health, it is essential to understand the perspectives, needs, and expectations of end users—within the specific care contexts where these technologies are implemented. The integration of person-centered care principles is critical to preserving the therapeutic and supportive relationship when mediated by technology.
Equitable digital health must go beyond issues of access, literacy, and motivation. It must be deeply rooted in integrated, person-centered care practices that respect individual values, preferences, and agency.
Guided by these principles, equitable digital health is expected to support strategies that promote well-being and enable self-management of chronic conditions through inclusive, responsive, and ethically grounded care.
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Person-centred care: from the conceptual models to its implementation
Care Systems, Organization, Models, and Technology