The inclusion and impact of digital determinants of health in digital nutrition interventions for adolescents: a systematic review.

Digital determinants of health (DDoH) is an emerging concept that captures domains relating to both digital health adoption and health equity. Digital transformations are reshaping many aspects of healthcare and health promotion, including how adolescent nutrition interventions are developed, delivered and utilized. As digital health interventions expand in popularity, it is crucial that they do not widen existing health disparities. This systematic review aimed to evaluate whether the DDoH are addressed in the development or delivery of digital nutrition interventions for adolescents, and whether this impacts access or use of these interventions to influence nutrition outcomes. Ten major electronic databases were searched and dual screened, capturing randomized controlled trials published from 2005 that aimed to improve nutrition outcomes through digital health interventions among adolescents 10-19 years. Primary outcome was objective or self-report change in nutrition intake or behaviours. DDoH assessment criteria were developed against nine pre-established dimensions. Study and intervention characteristics including information aligning with DDoH assessment criteria were extracted, and data synthesized in narrative format. Twenty articles representing 19 unique studies (13 246 participants) were identified, with 84% of studies conducted in high-income countries. All studies delivered interventions through mobile phone or computers and addressed at least one DDoH criteria. Affordability (100%) and usability (42%) were the most common DDoH criteria addressed. No studies successfully addressed all DDoH criteria. Therefore, we were unable to assess impact of addressing DDoH on adolescent nutrition outcomes. Overall, DDoH were inadequately addressed or reported in the development of digital nutrition interventions targeting adolescents.