Lessons for Vietnam on the use of digital technologies to support patient-centred care in low- and middle-income countries in the Asia Pacific Region: A scoping review (Preprint)

BACKGROUND Vietnam’s rapidly ageing population, shifting disease burden, and ongoing threat of potential infectious disease outbreaks are significant concerns for the country’s healthcare system. Health disparities are evident in many parts of the country, especially in rural areas, and the population faces inequitable access to quality, patient-centred healthcare. Vietnam must therefore explore and implement advanced solutions to delivering patient-centred care in a way that also reduces pressures on the healthcare system. Digital health technologies (DHTs) may be one of these solutions. OBJECTIVE To identify the application of DHTs to support the provision of patient-centred care in low- and middle-income countries (LMICs) in the Asia Pacific region (APR), and to draw lessons for Vietnam. METHODS A scoping review was undertaken. Systematic searches of seven databases were conducted to locate publications about DHTs and patient-centred care in the APR (January 2022). Thematic analysis was conducted, and DHTs were classified using the NICE Evidence Standards Framework for Digital Health and Care Technologies (Tiers A, B and C). Reporting was in line with PRISMA-ScR guidelines. RESULTS Of 264 publications located, 45 met inclusion criteria. The majority of DHTs were classified as Tier C (45.5%), followed by Tier B (42.4%) and Tier A (12.1%). Evidence suggested that DHTs can produce positive, patient-centred outcomes the individual and systems levels. At an individual level, DHTs increased accessibility of healthcare and health-related information, supported individuals in self- management, and lead to improvements in clinical and quality of life outcomes. At a systems level, DHTs supported patient-centred outcomes through increased efficiency, reduced strain on healthcare resources, and support for patient-centred clinical practice. Enablers and/or barriers for the use of DHTs for patient-centred care emerged at the level of the device or platform, the user, and the broader environment. The most frequently reported enablers included: (1) alignment of DHTs with users’ individual needs; (2) ease-of-use; (3) availability of direct support from healthcare professionals; (4) provision of technical support and user education and training; (5) appropriate governance of privacy and security; and (6) cross-sectional collaboration. Common barriers included: (1) low user literacy and/or digital literacy; (2) limited user access to DHT infrastructure, and (3) a lack of policies and protocols to guide the implementation and use of DHTs. CONCLUSIONS The use of DHTs is a viable option to increase equitable access to quality, patient-centred care across Vietnam, and simultaneously reduce pressures on the healthcare system. Vietnam can take advantage of the lessons learned by other LMICs in the APR when developing its national roadmap to digital health transformation. Recommendations that Vietnamese policymakers may consider include: (1) emphasise stakeholder engagement; (2) strengthen digital literacy; (3) support the improvement of DHT infrastructure; (4) increase cross-sectorial collaboration; (5) strengthen governance of cybersecurity; and (6) lead the way in DHT uptake. CLINICALTRIAL