Digital evolution and emerging inequalities in healthcare: a scoping review through the lens of knowledge management

Background: The rapid diffusion of digital technologies throughout the healthcare system has created new opportunities to improve the use, efficiency and continuity of healthcare services. The academic debate has largely explored the implementation of digital tools and their impact on clinical processes and health outcomes. Despite the potential benefits, the digital evolution of the healthcare system could generate or aggravate existing inequalities. Although existing studies on digital technologies in healthcare are consolidated and numerous, little attention has been paid to the emergence of inequalities at individual, organisational and system levels. To fill this gap, this study aims to focus on how emerging inequalities are framed in the academic debate, with a focus on the socio-demographic, technological and organisational factors of digital evolution of the healthcare system. This study is based on a knowledge management perspective. Methods: This study uses a scoping review approach and is carried out following the PRISMA-ScR guidelines. The search was conducted without time limits on three databases, and only peer-reviewed articles in English were included. The review included qualitative, quantitative and mixed-methods studies. Three analysis domains were identified: sociodemographic factors, technological factors and health and healthcare-related factors. A bibliometric and co-occurrence analysis was also conducted using VOSviewer to visualise the structure of the research landscape and identify thematic clusters. Results: From 3,303 reviewed articles, 64 studies met the inclusion criteria. The results highlight that the digital evolution of the healthcare system can exacerbate the exposure of new social categories to inequalities. The factors of emerging inequalities in the digital evolution of healthcare have been identified and classified into three areas: (1) socio-demographic factors, (2) technological factors and (3) organisational and systemic factors. Three different historical periods have been identified within the academic debate. In fact, through in-depth analysis and bibliometric analysis, we have observed an increasing diversification of the topics. Conclusion: Digitalisation of healthcare can generate inequalities. Although research on this topic in the literature is scarce, a growing number of scholars have begun to address it. Future research should explore user experiences, the effectiveness of healthcare provider training, coordination mechanisms and public reimbursement policies to reduce inequalities.