Digital Health Interventions and Access to Primary Health Care in Australia: Successes and Challenges

1. Introduction

Universal Health Coverage (UHC) refers to providing every person who needs health services with high-quality care without financial hardship [1]. As the World Health Organisation (WHO) concluded, Primary health care (PHC) is the most effective and cost-efficient method to achieve UHC [2]. The declaration of Alma-Ata in 1978 defined PHC as essential health care (usually at a fundamental level), which is universally accessible to the community with full community participation and affordable price [3].

Digital health uses information communication technologies (ICT) to assist health and health-related fields [4]. Digital health interventions can support clients, health service providers, and health systems or resource managers; they can also support a wide range of activities related to health data [5]. WHO highlighted the importance of digital health because it may help more significant numbers of people access some health services that were previously unavailable or unaffordable to them [6], which matches the Idea of UHC and PHC that provides affordable health services and increases accessibility [3]. Current evidence partially supports the idea of WHO that digital health can offer high-gain opportunities in specific segments; for instance, eHealth applications can increase the efficiency of general practitioners (GPs) by reducing the need for physical consultations and increasing the level of satisfaction of patients through 24/7 applicability as well as more straightforward and easier access [7]. Because related electronic devices have become more common at the health system level, primary health care assisted by digital techniques can cover more people, which was significant progress in PHC and UHC [8]. However, some researchers questioned the effectiveness and accuracy of current evidence [7,8]. This is because the nature of health systems across various countries and the building blocks of systems (such as health care delivery and health financing) are different; the generalisability of evidence would be limited [7,8,9,10]. Therefore, developing country-specific knowledge would be necessary to assess the success and challenges of digital health interventions in PHC. Furthermore, due to the inequity and inequality across populations under one health system [8,10], identifying a specific disadvantaged population for research would be meaningful. Health systems usually have poor consideration of linguistic and cultural diversity worldwide, and this problem is critical in digital health interventions to achieve UHC [8], so research on the population affected by this problem would be necessary.

Australia has applied efforts to build a PHC network to achieve UHC and has achieved some success. By 2021, 38.4% of health expenditure in Australia will be allocated to primary health care [11]. A Medicare system funded by the state or federal government was built to provide free or affordable health services and then reduce the out-of-pocket health expenditure of patients (Although some marginal groups still reported the price is unaffordable); most informants of this research presented strong satisfactory towards current Medicare system in Australia [12,13]. Privately operated GPs, which are Medicare-funded, deliver most of PHC services; some population groups or functions that were not covered by GPs would be supplemented by targeted public funding for services, which increased the range of coverage of PHC [13]. However, some challenges still exist, such as some patients, including First Nations peoples, face inequity when they need to access services like dental care and face non-communicable diseases [13]. Other challenges of PHC in Australia include poor leadership infrastructure, lack of training and clear job descriptions for health workers, community trust towards health services, and weak client engagement [12]. Overall, although some challenges are persistently hindering for the delivery of PHC services in Australia.

However, compared to the general population, priority populations, including people from Culturally and Linguistically Diverse (CALD) and First Nations backgrounds, the situation may be worse due to health inequity [14,15,16]. This is because economic issues such as poverty [17] or complex historical, geographic and socio-cultural factors, including colonisation and racism [18] faced by First Nations peoples, are systematically generating barriers to this population to obtain quality primary care. CALD people face similar circumstances, such as unequal distribution of power and resources, preventing them from equally accessing quality primary care [19]. Currently, the role of applying digital health in primary care is uncertain; the implementation of digital health can help disadvantaged population groups access quality health care [20] or reinforce the existing health inequity [8,21], and as we know, if DHIs have unique effects on the successes or challenges across among priority populations (First Nations and CALD populations) in Australia is still unclear.

To provide a deeper understanding of the role of DHIs in primary care and inform healthcare managers to address health inequities, this scoping review will examine the successes and challenges of digital health interventions in improving access to primary health care across different populations in Australia. 

2. Materials and Methods

2.1. Searching strategies

We conducted a search on four online databases: PubMed, Web of Science, Embase, Google Scholar, and one grey literature source, Australian Telehealth Society, to find research studies or articles related to the implementation of DHIs in the PHC area, the search terms were organised around three main themes: Digital health interventions, Primary health care, measurement of successful care, Australia background. Only database articles published in the last ten years (from 2014 to 2024) would be selected to ensure the timeliness of selected studies. There is no published time limit on grey literature. Boolean operators, truncations, and search terms were tailored to each database. Refer to the table in supplementary file S1 for details of searching strategies.

2.2. Study Selection

Selected papers would be imported into EndNote 20, and then duplicates would be removed. Afterwards, the titles and abstracts would be screened. Articles irrelevant to this study topic or have insufficient information in the title and/or abstract would be excluded. The quality of selected articles would be examined based on the Mixed Methods Appraisal Tool [22]. After the data screening, the final list will be checked and discussed. If there are no more disagreements, reviewers will conduct a full-text review independently. We obtained 1451 search results from PubMed, 916 results from Web of Science, 910 results from Embase, 17900 results from Google Scholar, and 45 from the Australian Telehealth Society [Figure 1 for a detailed search and screening process].

2.3. Data extraction and analysis

One reviewer extracted data based on study characteristics (author, year of publication, jurisdictions (states and territories), research focus duration of the study, study type/design, study participants (Which group of CALD people), sample size, The digital health interventions used, key findings and conclusions in the study). After the extraction, reviewers would recheck to ensure the content was accurate and complete. A thematic analysis was applied to gather articles presenting similar patterns around one theme and then identify successes and challenges of digital health interventions in improving access to primary health care among priority populations in Australia.

The health system building blocks, including Health Services Delivery, Health workforce, Health Governance and stewardship, and Health Information system, which the World Health Organisation concluded, were used as themes to help organise our findings [23]. In addition, community engagement, as an essential indicator of primary health, would also be selected as another significant theme [3].

The structure of this scoping review would follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist [24].

3. Results

3.1. Characteristics of included studies.

After excluding duplicate publications or articles with relatively low relevance to the current topic, 60 articles were selected. Of the chosen articles, 3 were cohort studies [25,26,27], 1 was a commentary article [28], 10 were critical, systematic or scoping reviews [29,30,31,32,33,34,35,36,37,38], 5 were cross-sectional studies [39,40,41,42,43], 5 were feasibility or pilot studies [44,45,46,47,48], 2 were government or organisation reports [49,50], 4 studies applied mixed-methods [51,52,53,54], 1 was randomised-controlled trails [55], 5 were studies applied other quantitative methods [56,57,58,59,60], 22 were qualitative studies [61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82], 2 studies have not specified their methodology or used different methods [83,84]. Refer to Supplementary Material 1 for detailed characteristics of selected studies and Table 1 for the overview of findings.

3.2. Critical characteristics of studies, success, and challenges of using digital health methods to promote primary health care in Australia.

3.2.1. Health service delivery (organised around the population)

For the general population, many successes were achieved regarding the efficiency of PHC delivery. For instance, both a new telehealth model in Central Australia [58] and a method of using apps and audio-visual media to provide nutrition education [75] were reported successful due to their time-saving function and improved efficiency. Two more DHIs in other PHC areas caused increased efficiency and extra fees, considering the additional cost was low. It would not affect the affordability of services; the overall success was supported [28,60].

Significantly, DHIs improved patients’ access to PHC services during Covid-19 [69]. DHIs also made PHC services accessible to older patients [69], persons disadvantaged due to socioeconomic, geographic or other reasons [27], and customers living in remote or regional areas [27,50]. What’s more, current PHC services delivery assisted by DHIs have good coordination with emergency referral stream operated by specialists [58], other health organisations and government departments [50] and PHC delivered by face-to-face services [69]. Notably, high comprehensiveness could be indicated by a single DHI that can provide symptom monitoring and management, goal setting, behavioural activation, and motivational counselling services [37], or DHI could deliver detailed risk assessment procedures in place for any patient who is at risk of suicide intention [27].

Overall, the use of telehealth in rural/remote Australia was increasing, which was a positive signal [31], but some mental health care providers suggested that the current telehealth method is not a standalone replacement for traditional professional management but instead a tool to support treatments [76]. Another challenge was the utilisation of a more effective telehealth method; video telehealth had significantly lower utilisation than traditional telephone telehealth [41]. As a feasibility test reported, too many study participants (older adults) never used mobile apps or dropped out, and too few used the app weekly, resulting in their ineffective intervention [44].

In the aspect of service quality, patients received quality and effective health care delivered through mobile apps and digital mental health interventions [27,76], a health education delivered through a social media campaign [50] and a Health Care Homes program assisted by digital technologies [84]. Nevertheless, ineffectiveness in some PHC areas was revealed, such as cardiovascular disease and diabetes management [44], could not support some complex clinical assessments [68] or failed to provide enough novelty, which is an important contributor to consumers’ engagement in an Infant health app [47]. Although few participants in a study reported negative experiences with their health Apps, concerns about addiction were raised by nonusers, indicating a challenge to the person-centeredness of service delivery that DHIs need to be more responsible for their clients [76].

For both the general population and a certain number of First Nations peoples living with them (usually in rural/remote contexts), some positive and similar comments were left on the improved accessibility of PHC brought by DHIs and emphasised it was meaningful to rural [36] and have geographical remoteness as well as no enough health staffs [80], reduced the health inequalities between metropolitan counterparts [45]. Another DHI, the virtual integrated general practices, also contributed to the success of the quality-of-service delivery that achieved its objectives, increasing participants’ willingness to use and improving efficiency by reducing the cost of travelling [45]. Besides, there is success in utilisation. Current health communication to cancer survivors is mainly delivered by digital health methods, and online resources are very important for those clients [34]. However, the services delivered by DHIs have low coverage and do not include relevant chronic and emergency care [12].

For HDIs that mainly deliver PHC services to First Nations peoples, there were successes in the quality of PHC service. An online alcohol and drug control program mentioned that the health education materials in this project presented a high level of written communication, good readability and usability [51]; First Nations-specific telehealth services improved First Nations patients’ confidence, then obtained positive health outcomes [51]. The efficiency improvement was also mentioned by First Nations peoples, who said that DHIs saved travel time, which can be reallocated to health service delivery [71]. However, the challenges to accessibility, such as language barriers in some DHIs [71] or the knowledge barrier caused by the use of complex medical jargon [51], still exist. Another challenge is the utilisation of telehealth is lower compared to face-to-face primary care [54]; as an article explained, some DHIs were a way to augment rather than replace face-to-face services [71].

For the general population, including a certain number of CALD people, DHIs were normally successful in improving efficiency among this research population. Telehealth reduced the economic burden on travel, parking, and accommodation, saved time, and improved overall efficiency, but the long waiting time can be challenging [81].

Overall, increased access to care is a common advantage of telehealth [81]; it could improve access to PHC for some vulnerable groups and rural area residents [42]. DHIs also provide people with impaired physical mobility an alternative way to access health services [79]. In addition, a cancer care website improved accessibility through its interactive functions [48]. However, for older adults, technical difficulties in login and website navigation performed as barriers to accessibility [48]; DHIs reduced access for CALD patients due to their non-English background was also reported [42].

There was a positive outcome regarding service quality, with DHIs being useful for some administrative work, such as organising follow-up appointments or facilitating return visits [79]. However, using digital methods to care for chronic disease in overweight and obese patients, except for a minor outcome, health literacy and diet at six months were positive, and the DHI did not affect most major outcomes [55]. Other quality problems of applied DHIs, including telehealth, did not perform well for complex or sensitive issues [81], health information delivered by social media is usually low quality [56], and missed or delayed diagnoses [42]. Patients did not receive centralised support or navigation, and poor quality of communication is another challenge [64], which also causes discomfort among CALD patients [64,81]. When searching for health information, the utilisation of telehealth or face-to-face GP service is nearly equal [56]. However, participants with CALD backgrounds have lower utilisation of DHIs; older adults and residents from rural areas are less likely to use PHC delivered through videos [25].

For the CALD population, the quality of PHC services delivered by digital methods is important. Some successes were achieved by using DHIs for health education to CALD people through the improvement of interested health outcomes, health literacy and intention to conduct cervical screening [46], which idea supported by another breast cancer health communication program that applying DHIs can improve the health knowledge and screening rates of breast cancer among CALD women [53]. However, some quality issues in translation were reported by CALD people seeking information resources on digital platforms [63] and maternity care mediated by telephone interpretation services [67]. Significantly, insufficient health information from social media became a common challenge specified by selected articles [61,83]; sometimes, bad-quality information even caused negative effects [43].

DHIs improved access to PHC services [29] and pre-travel health information [78]. A group of CALD parents outlined that online health information on child obesity could be accessed quickly, and video-based health education could also help those parents cross the language barrier [43]. However, due to the low availability or efficiency of Healthcare-specific interpreters [65] or considering that English sources were in a predominant position, CALD people still find it harder to access a broader range of information from domestic and international sources [26,43,74,77]. Furthermore, a challenging trend of DHI utilisation was revealed in CALD communities, including face-to-face interviews were more preferred to deliver PHC services [62], and DHIs were less likely to be used [83] compared to the general population or some CALD people from English-speaking countries [26].

Characteristics of DHI, including privacy and confidentiality, can facilitate CALD patients to reduce their shame and overcome previous experiences of being discriminated against [29], then improve the person-centeredness of services. Using social media and online messages to conduct health education was particularly acceptable among young CALD people [70], and online health education platforms run by health professionals or governments gained acceptance from the general CALD population [43]. However, ensuring health service delivery could cover all social groups in the targeted population (CALD population) was a critical challenge. For instance, during the online COVID-19 health communication program, a problem was presented: Health resources are mainly allocated to “high volume” CALD communities rather than “high demand” communities [77].

3.2.2. Health Workforce

Although online training for health workers has been successful in health services such as end-of-life care, the effectiveness of this DHI is still uncertain [57]. In another aspect of the supplies for health workers (human resources or funding), digital health can be used to overcome the challenges in areas such as staff shortages in aged care and rural/remote settings, then improve the accessibility of sleep care GP services [40]. Still, some healthcare providers expressed frustration about telehealth funding and its impact on facilitating their practices [68]. Notably, COVID-19 increased health providers’ skills in telehealth methods and eventually contributed to the success of multiple DHIs and service qualities [40].

Also, challenges were presented as low availability of training and tools, such as no proper tools to use, including limited appropriate technologies to support practitioners in delivering services [68] or difficulty finding appropriate technology due to the lack of efficiency or safety information [40]. Health worker training issues, including PHC providers having low familiarity with new digital health technologies [68,82], problematic training affordability [40], Extra workload and limited time brought by DHIs [40], are also presented as challenges for patients to access quality primary care. For health workers who provide DHIs in rural areas that have a relatively high proportion of First Nations residents (nearly 15%), the inadequate rural health workforce, as a health resource barrier, became a major challenge [33]. A study on health workers who mainly deliver services to First Nations peoples reported a similar challenge: additional staff are needed to support patients’ telehealth appointments [71]. The same study also illustrated other challenges, including the extra workload brought by telehealth and interpreters not being trained to translate some medical jargon, which may relate to language barriers caused by low translation quality [71]. Remarkably, DHIs enabled vulnerable staff to safely continue delivering services to their regular clients during the COVID-19 Pandemic, which is considered a success [71].

3.2.3. Health Information System (HIS)

For the general population, applying DHIs in PHC delivery enabled data collection and analysis during the health intervention, improved efficiency and expanded the data source simultaneously [27,75]. An article highlighted the success of the current health record system, “My Health Record”, in increasing the accessibility of health data for both patients and healthcare providers [39]. However, online platforms that could promote real-time share of health information have not been established in some specific PHC areas [57], and inequity of access for consumers with limited resources still exists [39], which were reported as challenges.

Research with the context of rural/remote Australia and includes Aboriginal health practitioners as participants and another research on HIS specifically designed for the First Nations peoples presented similar ideas that the functions of current HIS can ensure healthcare providers’ access to good quality data and improve their PHC delivery performance [38,80]. Moreover, the current Health information system in NT that has a data management function can lead to substantial improvements in the delivery of PHC. However, a key challenge was the lack of connectivity between HIS across different services [33]. In addition, in regional areas, healthcare providers faced challenges, including difficulties in operating the HIS, which resulted in low workflow efficiency and increased risk of errors [80] or inappropriate tools used, causing low data management efficiency [38], which eventually reduces the efficiency of service delivery. Besides, the current HIS is deeply connected with other health system components; any attempt at change or improvement would cause a severe documentation burden and then become a new challenge [38].

3.2.4. Medicine, Vaccines, diagnostic and technologies

In the area of nutrition education for the Australian general population, some digital technologies (such as photographs and nutrient analysis software) were considered successful in improving the efficiency and effectiveness of service delivery [75]. However, the challenge in technology affordability was that the high price of technology (retina camera) is commercially not practical for large-scale use for healthcare providers, resulting in a low eye screening rate [82]. Besides, technological infrastructure for videoconferencing to access GP services is unaffordable for disadvantaged patients with low socioeconomic status [41].

Accessibility and quality of technologies are the challenges faced by both people from the general population group and the First Nations people group. For example, the general population and First Nations peoples as participants reported the accessibility and utilisation of telehealth hardware (such as smartphone ownership) were low among the research population [49], especially in rural or remote Australia [66]. Also, the system-level uptake of telehealth technologies is slow [49], which caused the low accessibility of digital health services mediated by those infrastructures [66]. The quality of some current technologies is low, including unstable internet in rural or remote Australia [80], absence of some essential functions (for instance, auto-reminders) of technologies [66] and current technologies are usually designed for general purpose rather than specialised for clinical purpose [49], which may lead to the low quality of health services [49,66]. Research on First Nations peoples reported similar challenges: poor accessibility/utilisation of technologies (low smartphone ownership) and low quality of technology, such as bad internet in living areas of some First Nations peoples, causing poor communication audio quality in telehealth [71].

General and CALD participants outlined the lack of hardware devices to apply DHIs [64] and bad technology quality (phone call dropped), which can significantly reduce the experienced quality of care [81] as perceived challenges. Among research mainly designed for CALD patients, a study focused on electronic mental diagnosis methods suggests the test results generated from computerised neuropsychological assessments (CNAs) were more stable and accurate, then improved the overall quality of PHC [59]. The challenge of low availability and accessibility of telehealth devices (smartphones) exists in CALD patients as well [77] and might be even worse than in the general population [63]. Challenges included the quality issues of technologies, such as some DHIs being susceptible to technological difficulties [46] and an unstable Internet connection [35].

3.2.5. Community engagement

Some First Nations peoples received GP services delivered by mobile apps and found the apps are positioned in a way that counters rural community-centred norms, values, and culture and reduces community involvement, which presented not only a low person-centredness in service delivery but also a significant signal of the absence of community engagement [36]. Another challenge for some DHIs, such as cardiac rehabilitation services assisted by digital systems, local health providers and community leaders pointed out the need to improve coordination with different social groups, programs and service providers [66]. However, some successful community engagement has been achieved, such as healthcare providers developed online health education material with local First Nations communities, then eventually delivering services tailored for First Nations peoples with high cultural appropriateness and person-centeredness [51], or recruited First Nations researchers in the design process, then helped First Nations peoples overcome shame or previous experience of being discriminated [52] and enables First Nations peoples to access service in their country, then reduce their mental distress and alienation [32].

A co-design online health education program emphasised the success of involvement and empowerment of the CALD community members [46]. Moreover, when conducting health communication about COVID-19 in CALD communities, social media apps were heavily relied on to deliver health information and provide a platform for the officials to cooperate with local community leaders [77]. However, some DHIs presented a lack of community engagement through failure to provide culturally appropriate materials; for example, most DHIs aimed at suicide protection were designed for the general population, and they may not be able to cover the needs of minority groups, including CALD people [30]. Moreover, CALD patients reported a diabetes mobile app failed to provide details about culturally relevant foods and reduced the overall service quality [63]. Also, current LGBTQ+ health services websites could not satisfy the cultural needs of the Australian CALD LGBTIQ+ patients, increasing their social isolation [72].

4. Discussion

4.1. Summary of Findings

This scoping review identified the successes and challenges of applying digital health interventions in improving access to primary health care (PHC) among priority populations in Australia. In the aspect of health services delivery, the accessibility of health services obtained successes across the types of studies that involved the general population but were challenging in studies specifically designed for CALD or First Nations populations. For general and First Nations populations, the quality of PHC services delivered by DHIs is at a satisfactory level; although the DHIs presented some effectiveness for CALD people, the quality of the cultural- and language-specific content is usually low. All three populations reported improved efficiency brought by DHIs. However, the utilisation of quality DHIs is generally low between First Nations and CALD populations. To other health system building blocks, deeply related to Primary health service delivery, Ineffective health governance related to DHIs was presented as a challenge across all three populations. Health workforce using DHIs presented similar challenges across general and First Nations populations, including extra workload and inadequate supplies, and similar successes under COVID-19 settings. However, as special health workers, the interpreters are involved in special challenges for the First Nations population. The current HIS is successful for all populations in its main functions, but low inter-sector cooperation and inequities in accessing HIS between cities and rural/remote areas still exist for First Nations Peoples and some parts of general populations. Among both general and CALD populations, current technologies can improve overall quality but are insufficient in specific areas. However, for CALD and First Nations populations, the affordability of technologies limited their access to PHC. Although DHIs can improve community engagement with First Nations and CALD people through tailored and co-designed DHIs, for DHIs designed for the general population but applied to minority populations, there is a challenge of delivering PHCs in a way that priority populations can culturally accept. Moreover, current DHIs cannot cover all target population groups, such as “low volume” CALD groups or First Nations people.

The overview of the successes and challenges across building blocks and populations was listed in the table in Supplementary file S1. Current evidence suggests the challenges and successes of applying DHIs for priority populations to access the PHC are generally inconclusive; this finding is similar to previous reviews [8,85,86]. However, there are some critical patterns across the findings that were remarkable and useful for improving the access of PHC delivered by DHIs to the priority populations and will be interpreted with the comparison to existing research:

4.2. Tailored designs in DHIs are needed to help priority populations overcome cultural barriers.

Cultural barriers still exist and prevent both CALD and First Nations people from using DHIs to access quality PHC services. However, this barrier can be reduced with further DHIs tailored to the priority populations. We synthesised that many Patients from priority populations reported challenges on a lack of content with cultural appropriateness, and such failure of DHIs to satisfy the cultural needs of priority populations significantly limited the access of those people to quality health services [30,36,63,72]. This relation explains that an imprecise representation of the culture is related to fear towards DHIs or past traumas [87]. Interestingly, a common feature was revealed: Most of those DHIs facing challenges on cultural barriers were designed for the general public rather than tailored explicitly to priority populations. In contrast, patients from priority populations usually reported that DHIs tailored to them successfully reduced cultural barriers [32,46,51,52]. An idea of tailored design is key to overcoming cultural barriers, and it can be revealed. International evidence supported this idea that tailored DHIs improved access to services in particularly underserved groups, and a higher degree of target population involvement and co-design can reinforce this improvement [88,89]. The success of tailored design can be explained by such design usually involves co-design with members from priority populations or other forms of high community engagement, which engages First Nations and CALD peoples meaningfully in research, documenting their experiences and needs on different health areas, then ensures their cultural needs are acknowledged in those DHIs [90]. Although further studies on the role of tailored designs still need to be scrutinised to obtain a better understanding and improve the impact of these designs [89], the importance of tailored designs discovered from current evidence could provide insight for health managers or providers to deliver primary care assisted by DHIs to priority communities.

4.3. Language barriers faced by CALD and First Nations peoples are still significant.

Two important sub-themes were discovered from existing studies: challenges related to interpreters and a lack of community language resources. Both sub-themes suggest that the language barriers faced by CALD and First Nations populations are still significant. Many patients from priority populations faced language problems. The studies selected by us show in current DHIs, interpreters use the telephone or other online platforms such as Zoom to participate in health service delivery [65,71] or health education programs, and health providers translate English health information into community languages [26,43,74,77] are major ways used to address the language barrier. However, current evidence shows the interpreter service may present low quality, efficiency, or availability, especially when complex medical jargon or rural/remote context is involved. Also, community language resources are absent or have poor translation quality. As other studies agreed, such challenges limited the progress of addressing current language barriers, limiting priority populations’ ability to use DHIs to access quality PHC services [91,92,93]. Although there are alternative options to overcome the language barrier which were not mentioned in the articles selected by us, such as using translation apps to ensure the service could be delivered without interpreters [94,95], those two articles related to this option did not mention there is a large-scale use of this method existing. In addition, some evidence suggests that such alternative options could have severe accuracy problems [96,97], which may help explain why this alternative method did not affect the conclusion on language barriers made by our study. Hence, this research emphasises that language barriers are still challenging for priority populations, and an explanation was provided. As a cross-sectional study suggests, future improvements may still need to focus on creating supporting infrastructure and health e-literacy at system levels and facilitating interpreters to support telehealth interactions [91].

4.4. The role of DHIs in relation to the regional digital divide faced by First Nations peoples.

Poor internet connection is an important challenge to applying DHIs in priority studies. In studies, our research synthesised that such insufficient DHI technology infrastructure is significantly severe among First Nations peoples, indicating the regional digital divide is still lasting. According to the article we selected, some challenges of technological infrastructure are faced by First Nations peoples, such as unstable internet [71,80] or inadequate hardware or devices to receive DHIs [25,66]. Notably, nearly all of the research was done in a rural/remote context. This challenge is shared by other local residents who are more likely to belong to the general population group [25,66,80]. The listed evidence suggests that although developing digital health methods can help overcome the geographical barrier, the digital divide between rural areas and city areas may still be significant, contributing to the challenges faced by First Nations Peoples in using DHIs to access quality PHC services. This idea was supported by previous studies [98,99]. Furthermore, the idea claimed by an article that COVID-19 ensure the funding of rural digital health, hence a key barrier preventing telehealth from securing its place in rural areas would be addressed [100]. Our evidence opposed this claim that the funding problem is still a concern for rural healthcare providers using DHIs [68]. Notably, admitting the significance of the digital divide does not mean denying the potential DHIs in overcoming this barrier. With the development in the digital health area, multiple successes in improving rural access to PHC services mediated by DHIs were listed in our results section [27,32,36,45,50,71,80]. The idea that the gap between urban and rural areas has not been reduced [99] can be opposed, and DHIs’ ability to overcome the regional digital divide could be supported. To conclude, the role of the regional digital divide in our topic has been examined. Efforts from healthcare providers and managers are needed to address this gap and improve the health and well-being of First Nations peoples.

4.5. Limitations

This scoping review has some limitations. Firstly, many of the selected articles (36%) are qualitative studies. Because one qualitative study could generate multiple ideas, collecting and presenting all those ideas would be extremely hard. Hence, this study only selected those “most relevant points”. Such a process may result in data loss and may cause some deviations from the real situation. To overcome this limitation, further studies can limit the inclusion of studies to ensure the proportion of other types of studies. Since the methodology is a scoping review, no standardised measurement exists to examine the effect size of each success and challenge. Therefore, we can only map the results obtained from different studies and explain patterns rather than explaining to what extent current DHIs are successful or facing challenges. Based on this limitation, a further systematic review of this topic would be recommended to obtain a more “quantified” result. Moreover, as some selected studies indicated, the First Nations and CALD peoples have a broad label, and the successes and challenges may vary across different sub-groups in each population. Therefore, more detailed and more profound studies on each population and its sub-groups are welcomed.

5. Conclusions

Digital health interventions hold promise in bolstering access to quality primary care for patients. Nonetheless, formidable challenges persist within various healthcare subdomains, spanning different health systems building blocks and demographic groups, rendering the overall evidence inconclusive and uncertain. Nonetheless, amid this complexity, certain noteworthy trends emerge. For instance, digital health interventions demonstrate the potential to mitigate language and cultural barriers encountered by priority populations and address the digital disparity among First Nations communities. Analysis of existing research reveals that despite the critical importance of high-quality interpreters and translated materials in facilitating access for priority populations, proposed alternative approaches have not substantially impacted the efficacy of digital health interventions. While the regional digital divide remains pronounced, digital health interventions exhibit promise in surmounting this obstacle. Cultural barriers persist, but tailored designs of digital health interventions offer promise in assisting priority populations in overcoming this challenge. These underlying patterns of success and challenge furnish a nuanced comprehension of the role of digital health interventions in primary care, thereby equipping healthcare managers with insights to combat health disparities across diverse demographics.