Support Strategies and Interventions for eHealth Inclusion: Scoping Review

Background: Policymakers increasingly promote eHealth as a way to improve healthcare efficiency. However, digitalization risks excluding individuals and groups who cannot fully engage with eHealth—for example, due to limited digital literacy or restricted access to resources. Targeted support, such as skills training, personalized guidance, or system-level initiatives, may help, but evidence on how such support is organized and whether it is effective remains limited. Objective: This scoping review aimed to map proposed strategies to promote eHealth inclusion, identify concrete support interventions, and report evidence on their outcomes Methods: This scoping review followed Arksey and O’Malley’s framework and the PRISMA-ScR guidelines. We searched PubMed, Scopus, Web of Science, and Embase for peer-reviewed studies published from 2014 onwards. We included empirical studies reporting on support to enhance eHealth inclusion. In total, 40 studies met the criteria: 19 examined support strategies and 21 evaluated targeted interventions. Strategies and interventions were categorized by actors at the micro level (interpersonal, such as family members, friends, or peers), meso level (organizations, such as healthcare organizations or community organizations), and macro level (policy or system). Results: Support strategies and interventions addressed a range of eHealth types, including video consultations, mobile health applications, and patient portals. Strategy studies often emphasized interpersonal support from family, friends, or peers, whereas interventions more often involved healthcare providers. Intervention outcomes, as identified during analysis, were grouped into adoption, use, skills, and attitudes. Adoption-focused interventions led by healthcare organizations showed limited effectiveness. Interventions targeting use partly demonstrated positive effects, such as increased completion of video visits, whereas outcomes related to attitudes were mixed. Nearly all multi-actor interventions—combining efforts across micro, meso, and macro levels—effectively improved eHealth skills, including digital and eHealth literacy. Examples include programs linking healthcare providers with community organizations, and initiatives pairing students with older adults, both of which improved these skills. Regional differences were also observed: healthcare providers played a dominant role in studies from the United States, community organizations were more prominent in African contexts, and multi-actor approaches were common in European studies. Conclusions: Overall, interventions yielded mixed results, but multi-actor collaborations frequently improved eHealth skills. These findings underscore the value of combining interpersonal, organizational, and policy-level efforts when designing support structures. For healthcare organizations, initiatives led solely by healthcare actors may suffice for promoting the use of specific applications (such as video consultations), but they seem insufficient for fostering broader eHealth literacy. Future research should address the sustainability and scalability of multi-actor interventions and how health system contexts and cultural factors shape their outcomes. Clinical Trial: Open Science Framework (OSF) 0.17605/OSF.IO/YRWFD; https://osf.io/6qmcj/overview