How Older Indigenous Women Living in High-Income Countries Use Digital Health Technology: Systematic Review

Abstract

Background: Research associated with digital health technologies similar to the technologies themselves has proliferated in the last 2 decades. There are calls for these technologies to provide cost-effective health care for underserved populations. However, the research community has also underserved many of these populations. Older Indigenous women are one such segment of the population.

Objective: Our objective is to systematically review the literature to consolidate and document what we know about how older Indigenous women living in high-income countries use digital health technology to enhance their health.

Methods: We analyzed the peer-reviewed literature by systematically searching 8 databases in March 2022. We included studies published between January 2006 and March 2022 with original data specific to older Indigenous women from high-income countries that reported on the effectiveness, acceptability, and usability of some user-focused digital health technology. We incorporated 2 measures of quality for each study. We also conducted a thematic analysis and a lived experience analysis, which examined each paper from the perspectives of older Indigenous women. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in this study.

Results: Three papers met the inclusion criteria. The key findings were that older Indigenous women do not see themselves reflected in mainstream health messaging or other digital health offerings. They prefer an approach that considers their uniqueness and diversity. We also identified 2 significant gaps in the literature. First, research reporting on older Indigenous women from high-income countries' experiences with digital health technology is minimal. Second, the limited research related to older Indigenous women has not consistently engaged Indigenous people in the research process or governance.

Conclusions: Older Indigenous women want digital health technologies to respond to their needs and preferences. Research is needed to understand their requirements and preferences to ensure equity as we move toward greater adoption of digital health technology. Engaging older Indigenous women throughout the research is essential to ensuring that digital health products and services are safe, usable, effective, and acceptable for older Indigenous women.

Keywords: Aboriginal; Aboriginal and Torres Strait Islander; Indigenous; PRISMA; acceptability; co-design; cultural safety; digital health; elder; engagement; ethic; gerontology; health technology; lived experience; minorities; minority; older Ingenuous women; older adult; older women; patient experience; preference; review methodology; social media; systematic review; usability; wearable.

Figure 1

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram of study selection [30].