Addressing health service equity through telehealth: A systematic review of reviews

Abstract

Objective To synthesize existing reviews on the impact of telehealth programs on health service equity in non-urban areas, focusing on six dimensions of access: accessibility, availability, acceptability, affordability, adequacy, and awareness. Methods We included systematic and non-systematic reviews published from 2012 to 2023 on telehealth interventions in rural or remote settings. Content was mapped to the six dimensions, and coverage within each dimension was rated based on predefined criteria. Results A total of 42 reviews (43% systematic) were identified. Most reviews (90.5%) addressed at least one dimension, yet comprehensive coverage was rare. Acceptability had the highest number of “good” ratings (24%), while awareness was the least explored. Gaps included digital literacy, infrastructure challenges, and cultural barriers—factors critical to equitable telehealth access. Cost-effectiveness analyses were also limited, leaving affordability underexamined. Conclusion Telehealth shows promise for improving healthcare access in non-urban regions. However, existing reviews often provide incomplete assessments across the six dimensions. This suggests a need for clearer, more robust evaluation frameworks to ensure more comprehensive reporting of equity impacts in telehealth research.