Concordance between 8-1-1 HealthLink BC Emergency iDoctor-in-assistance (HEiDi) virtual physician advice and subsequent health service utilization for callers to a nurse-managed provincial health information telephone service.

BACKGROUND: British Columbia 8-1-1 callers who are advised by a nurse to seek urgent medical care can be referred to virtual physicians (VPs) for supplemental assessment and advice. Prior research indicates callers' subsequent health service use may diverge from VP advice. We sought to 1) estimate concordance between VP advice and subsequent health service use, and 2) identify factors associated with concordance to understand potential drivers of discordant cases. METHODS: We linked relevant provincial administrative databases to obtain inpatient, outpatient, and emergency service use by callers. We developed operational definitions of concordance collaboratively with researcher, patient, VP, and management perspectives. We used Kaplan-Meier curves to describe health service use post-VP consultation and Cox regression to estimate the association of caller factors (rurality, demography, attachment to primary care) and call factors (reason, triage level, time of day) with concordance as hazard ratios. RESULTS: We analyzed 17,188 calls from November 16, 2020 to April 30, 2021. Callers advised to attend an emergency department (ED) immediately were the most concordant (73%) while concordance was lowest for those advised to seek Family Physician (FP) care either immediately (41%) or within 7 days (47%). Callers unattached to FPs were less likely to schedule an FP visit (hazard ratio = 0.76 [95%CI: 0.68-0.85]). Rural callers were less likely to attend an ED within 48 h when advised to go immediately (0.53 [95%CI:0.46-0.61]) compared to urban callers. Rural callers advised to see an FP, either immediately (1.28 [95%CI:1.01-1.62]) or within 7 days (1.23 [95%CI: 1.11-1.37]), were more likely to do so than urban callers. INTERPRETATION: Concordance between VP advice and subsequent caller health service use varies substantially by category of advice and caller rurality. Concordance with advice to "Go to ED" is high overall but to access primary care is below 50%, suggesting potential issues with timely access to FP care. Future research from a patient/caller centered perspective may reveal additional barriers and facilitators to concordance.

Real-Time Virtual Support as an Emergency Department Strategy for Rural, Remote, and Indigenous Communities in British Columbia: Descriptive Case Study.

BACKGROUND: British Columbia has over 200 rural, remote, and Indigenous communities that have limited health care resources due to physician isolation, sparsity in clinical resources, the lack of collegial support, and provider burnout. Real-time virtual support (RTVS) peer-to-peer pathways provide support to patients and providers. Amid the COVID-19 pandemic exacerbating existing health care disparities and equitable access to timely care, RTVS presents a portable and additional opportunity to be deployed in a hospital or patient home setting in rural communities. We highlight the story of the Rural Urgent Doctor in-aid (RUDi) pathway within RTVS that successfully supported the Dawson Creek District Hospital (DCDH) emergency department (ED) in 2021. OBJECTIVE: This study aims to describe the rapid implementation process and identify facilitators and barriers to successful implementation. METHODS: This case study is grounded in the Quadruple Aim and Social Accountability frameworks for health systems learning. The entire study period was approximately 6 months. After 1 week of implementation, we interviewed RUDi physicians, DCDH staff, health authority leadership, and RTVS staff to gather their experiences. Content analysis was used to identify themes that emerged from the interviews. RESULTS: RUDi physicians covered 39 overnight shifts and were the most responsible providers (MRPs) for 245 patients who presented to the DCDH ED. A total of 17 interviews with key informants revealed important themes related to leadership and relationships as facilitators of the coverage's success, the experience of remote physician support, providing a "safety net," finding new ways of interprofessional collaboration, and the need for extensive IT support throughout. Quality improvement findings identified barriers and demonstrated tangible recommendations for how this model of support can be improved in future cases. CONCLUSIONS: By acting as the MRP during overnight ED shifts, RUDi prevented the closure of the DCDH ED and the diversion of patients to another rural hospital. Rapid codevelopment and implementation of digital health solutions can be leveraged with existing partnerships and mutual trust between RTVS and rural EDs to ease the pressures of a physician shortage, particularly during COVID-19. By establishing new and modified clinical workflows, RTVS provides a safety net for rural patients and providers challenged by burnout. This case study provides learnings to be implemented to serve future rural, remote, and Indigenous communities in crisis.

"I don't think they're as culturally sensitive": a mixed-method study exploring e-mental health use among culturally diverse populations.

BACKGROUND: Culturally diverse populations (CDPs), such as visible minorities, face challenges, such as lack of culturally tailored resources, when accessing mental health services. These barriers may be addressed by e-mental health (eMH) technologies. However, little attention has been devoted to understanding the cultural responsiveness of these services among CDPs. AIMS: This study explores CDPs experience of eMH for anxiety and depressive disorders in an urban area and gauge its cultural responsiveness. METHODS: In this mixed methods study, participants (N = 136) completed a survey regarding their eMH use, mental health status, and socio-demographic characteristics. Subsequently, participants (N = 14) shared their experiences through semi-structured focus groups. RESULTS: The majority of participants (68%) indicated that the eMH resources used were not culturally tailored. However, most participants (65%) agreed that the resource was available in their preferred language. Focus group discussions revealed key experiences around limited language diversity, cultural representation and cultural competency, and culturally linked stigma. eMH recommendations suggested by participants focused on including culturally tailored content, graphics and phrases, and lived experiences of CDPs. CONCLUSIONS: The findings showcase the need for more culturally responsive eMH beyond language translation, while providing healthcare professionals with a greater and nuanced understanding of treatment needs in cultural groups.

Real-time virtual supports improving health equity and access in British Columbia.

In British Columbia (BC) and across the territories of over 200 First Nations and 39 Métis Nation Chartered communities, the COVID-19 pandemic catalyzed a group of partner organizations to rapidly establish seven virtual care pathways under the Real-Time Virtual Support (RTVS) network. They aimed to address inequitable access and multiple barriers to healthcare faced by rural, remote, and Indigenous communities, and provide pan-provincial services. Mixed-method evaluation assessed implementation, patient and provider experience, quality improvement, cultural safety, and sustainability. Pathways supported 38,905 patient encounters and offered 29,544 hours of peer-to-peer support from April 2020 to March 2021. Mean monthly encounter growth was 178.0% (standard deviation = 252.1%). Ninety percent of patients were satisfied with the care experience; 94% of providers enjoyed delivering virtual care. Consistent growth suggests that the virtual pathways met the needs of providers and patients in rural, remote, and Indigenous communities, and supported virtual access to care in BC.

Barriers and Facilitators to Accessing Digital Health Tools Faced by South Asian Canadians in Surrey, British Columbia: Community-Based Participatory Action Exploration Using Photovoice.

BACKGROUND: South Asian community members in Canada experience a higher burden of chronic disease than the general population. Digital health innovations provide a significant opportunity to address various health care challenges such as supporting patients in their disease self-management. However, South Asian community members are less likely to use digital tools for their health and face significant barriers in accessing them because of language or cultural factors. OBJECTIVE: The aim of this study is to understand the barriers to and facilitators of digital health tool uptake experienced by South Asian community members residing in Canada. METHODS: This study used a qualitative community-based participatory action research approach. Residents from Surrey, British Columbia, Canada, who spoke 1 of 4 South Asian languages (Hindi, Punjabi, Urdu, or Tamil) were invited to participate in focus group discussions. A subsample of the participants were invited to use photovoice methods in greater depth to explore the research topics. RESULTS: A total of 197 participants consented to the focus group discussions, with 12 (6.1%) participating in the photovoice phase. The findings revealed several key obstacles (older age, lack of education, and poor digital health literacy) and facilitators (social support from family or community members and positive attitudes toward technology) to using digital health tools. CONCLUSIONS: The results support the value of using a community-based participatory action research approach and photovoice methods to engage the South Asian community in Canada to better understand digital health competencies and needs. There were several important implications for policy makers and future research, such as continued engagement of community leaders by health care providers and administrators to learn about attitudes and preferences.

Perceived Effectiveness and Motivations for the Use of Web-Based Mental Health Programs: Qualitative Study.

BACKGROUND: The prevalence of depression is high and has been stable despite increased treatment, research, and dissemination. People encounter barriers to seeking traditional mental health services, which could be mitigated by using web-based prevention methods. OBJECTIVE: This study aims to understand what people at high risk for depression perceive as effective aspects of web-based mental health programs and what motivates people at high risk for depression to use web-based mental health programs. METHODS: We conducted an inductive content analysis using telephone interview data from 77 participants at high risk for depression who were recruited from 2 randomized controlled trials (RCTs). Participants from the first RCT were working men who had been randomly assigned to 1 of the following 3 groups: control group, who had access to general depression information from a website called BroMatters; intervention group 1, who had access to the BroMatters website along with the associated BroHealth web-based mental health program; and intervention group 2, who had access to the BroMatters website, the BroHealth web-based mental health program, and telephone sessions with a life coach. Participants from the second RCT were men and women who had been assigned to the intervention group, who received access to the HardHat web-based mental health program, or the control group, who only received access to the HardHat web-based mental health program following completion of the RCT. Participants for this inductive content analysis study were recruited from the intervention groups in both RCTs. Two groups of participants (n=41 and n=20) were recruited from the BroHealth RCT, and a third group comprised 16 participants that were recruited from the HardHat RCT. RESULTS: We generated four categories regarding the perceived effectiveness of web-based programs and five categories related to what motivates the use of web-based programs. Participants identified awareness, program medium and functionality, program content, and coaches as categories related to the effectiveness of the programs. Categories of motivators to use web-based programs included providing reminders or incentives, promotion of the programs, providing appropriate medium and functionality, appropriate content, and perceived need. The final category related to motivators reflects perceptions of participants who were either unsure about what motivates them or believed that there is no way to motivate use. CONCLUSIONS: Conflicting evidence was obtained regarding the perceived effectiveness of aspects of the content and functionality of web-based programs. In general, web-based mental health programs were perceived to help increase mental health awareness, especially when it includes live access to a coach. However, the results also revealed that it is difficult to motivate people to begin using web-based mental health programs. Strategies that may motivate the use of such programs include perceived personal need, effective promotion, providing incentives and reminders, and improving functionality.

Remote assessment via video evaluation (RAVVE): a pilot study to trial video-enabled peer feedback on clinical performance.

BACKGROUND: Video review processes for evaluation and coaching are often incorporated into medical education as a means to accurately capture physician-patient interactions. Compared to direct observation they offer the advantage of overcoming many logistical challenges. However, the suitability and viability of using video-based peer consultations for professional development requires further investigation. This study aims to explore the acceptability and feasibility of video-based peer feedback to support professional development and quality improvement in patient care. METHODS: Five rheumatologists each provided four videos of patient consultations. Peers evaluated the videos using five-point scales, providing annotations in the video recordings, and offering recommendations. The rheumatologists reviewed the videos of their own four patient interactions along with the feedback. They were asked to document if they would make practice changes based on the feedback. Focus groups were conducted and analysed to explore the effectiveness of video-based peer feedback in assisting physicians to improve clinical practice. RESULTS: Participants felt the video-based feedback provided accurate and detailed information in a more convenient, less intrusive manner than direct observation. Observations made through video review enabled participants to evaluate more detailed information than a chart review alone. Participants believed that reviewing recorded consultations allowed them to reflect on their practice and gain insight into alternative communication methods. CONCLUSIONS: Video-based peer feedback and self-review of clinical performance is an acceptable and pragmatic approach to support professional development and improve clinical care among peer clinicians. Further investigation into the effectiveness of this approach is needed.

The Use of eHealth Applications in Hong Kong: Results of a Random-Digit Dialing Survey.

eHealth has become popular worldwide, and it is transforming health care. However, studies examining  the use of eHealth applications in the Chinese population are scarce. The study reports on the characteristics of eHealth applications in Hong Kong information and communication technology (ICT) users, their attitudes towards eHealth, and their reasons for not using eHealth applications. A cross-sectional random-digit dialing survey targeting adults using ICT was conducted in Hong Kong to elicit information on respondents' use of and attitudes towards eHealth. A total of 495 ICT users completed the survey, of whom 353 (71.3%) were eHealth users. A smartphone was the most frequent way of performing eHealth activities (71.7%). The most prevalent eHealth activity was reading about health/illness (86.4%), with 93.5% indicating that eHealth applications improved their understanding of health care issues. People with less education were less likely to use eHealth applications. Non-eHealth users indicated that the main reasons for not using eHealth applications were lack of interest in health information (49.3%) and lack of confidence in the reliability of online information (45.1%). Quality monitoring of health information available on ICTs and tailoring the design and readability are recommended to meet the needs of those seeking health resources and to promote eHealth. Evidence from the study demonstrates the potential of eHealth to improve the dissemination of health information in Hong Kong, and it provides a basis for improving eHealth integration.

Knowledge to action framework for home health monitoring.

Chronic disease management is a grand challenge, both to the patients for optimal management and to the overall health system with cost utilization. Emerging research evidence suggests that Home Health Monitoring (HHM) using home-based, remoting monitoring technologies can improve the patients' quality of life, self-management, and achieve cost-effectiveness for the health system. How should HHM be introduced and integrated appropriately into the current healthcare delivery pathways to improve patient care and collect evidence of benefits simultaneously? The Knowledge to Action (KTA) framework is an effective approach in the implementation science literature to methodically guide the translation of evidence-based research findings into practice, putting knowledge into practical use. This article examines the use of the seven-step KTA model to address implementation facilitators and barriers of applying HHM in chronic disease management and then focus on its applicability on chronic obstructive pulmonary disease as an example.

Process and findings informing the development of a provincial emergency medicine network.

We describe the process undertaken to inform the development of the recently launched British Columbia (BC) Emergency Medicine Network (EM Network). Five methods were undertaken: (1) a scoping literature review, (2) a survey of BC emergency practitioners and EM residents, (3) key informant interviews, (4) focus groups in sites across BC, and (5) establishment of a brand identity. There were 208 survey respondents: 84% reported consulting Internet resources once or more per emergency department shift; however, 26% reported feeling neutral, somewhat unsatisfied, or very unsatisfied with searching for information on the Internet to support their practice. Enthusiasm was expressed for envisioned EM Network resources, and the key informant interviews and focus group results helped identify and refine key desired components of the EM Network. In describing this, we provide guidance and lessons learned for health leaders and others who aspire to establish similar clinical networks, whether in EM or other medical disciplines.

Clinical Texting Among Medical Trainees of the University of British Columbia [Formula: see text].

We believe cellphone text messages are commonly used in medical practice whether in rural or urban settings and that clinical photos are often attached to them. Our interest is the use of this technology to provide dermatology service to rural and remote British Columbia. Concern has been expressed about the security of confidential information and adequacy of privacy protection in such an application. We have found little published information about the extent of texting in rural and remote settings (and none in our jurisdiction) or the number and nature of privacy breaches that have actually occurred as a result. To obtain such information, we first set out to survey medical practitioners about their actual use. The results reported here are from medical trainees enrolled with the University of British Columbia who are in both rural and urban settings.

Engaging patients as partners in health research: Lessons from BC, Canada.

Canada is seeing increased interest in engaging patients in health research, recognizing the potential to improve its relevance and quality. The momentum is promising, but there may be a tendency to ignore the challenges inherent when lay people and professionals collaborate. We address some of these challenges as they relate to recruitment, training, and support for patients at the British Columbia (BC) Support for People and Patient-Oriented Research Unit, part of Canada's Strategy for Patient-Oriented Research. A retrospective review of a telehealth project demonstrates that, as well as the practical elements of recruitment, training, and support, attention must be paid to issues of credibility, legitimacy, and power when engaging patients. We propose that all patient-oriented research projects would benefit from using a similar framework to guide patient engagement planning and implementation, helping to anticipate and mitigate challenges from the outset. Projects would ideally also include the study of patient engagement methods, to add to this important body of knowledge.

Preferred Features of E-Mental Health Programs for Prevention of Major Depression in Male Workers: Results From a Canadian National Survey.

BACKGROUND: Major depression is a prevalent mental disorder and imposes considerable burden on health and productivity. Men are not immune to major depression, yet they often delay seeking help because of perceived stigma and gender norms. E-mental health programs hold potential for early prevention of major depression. However, we have little knowledge about men's preferences for design features of e-mental health programs. OBJECTIVES: The objective of this study was to (1) estimate and compare the proportions of Internet use for medical information, preferred design features, and likely use of e-mental health programs; (2) examine factors associated with the likely use of e-mental health programs; and (3) understand potential barriers to the use of e-mental health programs among Canadian working men, who were at high risk of a major depressive episode (MDE). METHODS: A cross-sectional survey in 10 Canadian provinces was conducted between March and December 2015. Random digit dialing method was used through household landlines and cell phones to collect data from 511 working men who were at high risk of having an MDE and 330 working men who were at low risk of having an MDE. RESULTS: High-risk men were more likely to endorse the importance of accessing health resources on the Internet than low-risk men (83.4% vs 75.0%, respectively; P=.01). Of the 17 different features assessed, the top three features most likely to be used by high-risk men were: "information about improving sleep hygiene" (61.3%), "practice and exercise to help reduce symptoms of stress and depression" (59.5%), and "having access to quality information and resources about work stress issues" (57.8%). Compared with men at low risk for MDE, men at high risk for MDE were much more likely to consider using almost every one of the different design features. Differences in preferences for the design features by age among men at high risk of MDE were found only for 3 of 17 features. Differences in preferences for design features between English- and French-speaking participants were found only for 4 out of the 17 features. Analysis of qualitative data revealed that privacy issues, perceived stigma, ease of navigation, personal relevance, and lack of personal interaction, time, and knowledge were identified as barriers to the use of e-mental health programs in working men who were at high risk of MDE. CONCLUSION: E-mental health programs may be a promising strategy for prevention of depression in working men. Development of e-mental health programs should consider men's preferences and perceived barriers to enhance the acceptability of this approach.

Medical students' self-reported preparedness and attitudes in providing care to ethnic minorities.

BACKGROUND: To assess medical students' self-reported preparedness to provide care to ethnic minorities, factors that influence preparedness, and attitudes toward cultural competency training. METHODS: A cross-sectional study, which invited University of British Columbia medical students to participate in a survey on student demographics, knowledge and awareness, preparedness and willingness, and personal attitudes. Of 1024, eligible, 301 students consented to study. RESULTS: Students across all year levels felt significantly less ready to provide care for non-English speaking Chinese patients compared to "any" patients. Proficiency in working with interpreters was correlated with readiness, OR 4.447 (1.606-12.315) along with 3rd and 4th year level in medical school, OR 3.550 (1.378-9.141) and 4.424 (1.577-12.415), respectively. Over 80% of respondents reported interest in learning more about the barriers and possible ways of overcoming them. CONCLUSIONS: More opportunities for cultural competency training in the medical curriculum are warranted and would be welcomed by the students.

Harnessing the social web for health and wellness: issues for research and knowledge translation.

Social media is a powerful, rapid, and popular way of communication amongst people around the world. How can health professionals and patients use this strategy to achieve optimal disease management and prevention and attainment of wellness? An interdisciplinary group at University of British Columbia, supported by a grant from UBC Peter Wall Institute of Advanced Studies, conducted a research workshop in February 2013 to explore what is known and yet to be researched in using social media for nurturing the growth of virtual communities of people for health and wellness. This two and a half day workshop brought together a group of 30 multidisciplinary experts in closed discussions to reflect on five research themes in detail: (1) individual information acquisition and application, (2) community genesis and sustainability, (3) technological design issues, (4) knowledge management, dissemination, and renewal, and (5) research designs. In addition, a public forum for the general public, which attracted over 195 live participants, over 100 participants via Web casting, 1004 tweets, and 1,124,886 impressions following the #HCSMForum hash tag on Twitter, demonstrated the keen interest of the general public in this topic. Key concepts were captured in JMIR publications in this issue, and future directions, including research, knowledge translation approaches, and strategic partnerships of interdisciplinary researchers with policy makers and industries emerged from the workshop proceedings.

Social media: a review and tutorial of applications in medicine and health care.

BACKGROUND: Social media are dynamic and interactive computer-mediated communication tools that have high penetration rates in the general population in high-income and middle-income countries. However, in medicine and health care, a large number of stakeholders (eg, clinicians, administrators, professional colleges, academic institutions, ministries of health, among others) are unaware of social media's relevance, potential applications in their day-to-day activities, as well as the inherent risks and how these may be attenuated and mitigated. OBJECTIVE: We conducted a narrative review with the aim to present case studies that illustrate how, where, and why social media are being used in the medical and health care sectors. METHODS: Using a critical-interpretivist framework, we used qualitative methods to synthesize the impact and illustrate, explain, and provide contextual knowledge of the applications and potential implementations of social media in medicine and health care. Both traditional (eg, peer-reviewed) and nontraditional (eg, policies, case studies, and social media content) sources were used, in addition to an environmental scan (using Google and Bing Web searches) of resources. RESULTS: We reviewed, evaluated, and synthesized 76 articles, 44 websites, and 11 policies/reports. Results and case studies are presented according to 10 different categories of social media: (1) blogs (eg, WordPress), (2) microblogs (eg, Twitter), (3) social networking sites (eg, Facebook), (4) professional networking sites (eg, LinkedIn, Sermo), (5) thematic networking sites (eg, 23andMe), (6) wikis (eg, Wikipedia), (7) mashups (eg, HealthMap), (8) collaborative filtering sites (eg, Digg), (9) media sharing sites (eg, YouTube, Slideshare), and others (eg, SecondLife). Four recommendations are provided and explained for stakeholders wishing to engage with social media while attenuating risk: (1) maintain professionalism at all times, (2) be authentic, have fun, and do not be afraid, (3) ask for help, and (4) focus, grab attention, and engage. CONCLUSIONS: The role of social media in the medical and health care sectors is far reaching, and many questions in terms of governance, ethics, professionalism, privacy, confidentiality, and information quality remain unanswered. By following the guidelines presented, professionals have a starting point to engage with social media in a safe and ethical manner. Future research will be required to understand the synergies between social media and evidence-based practice, as well as develop institutional policies that benefit patients, clinicians, public health practitioners, and industry alike.

From Today to Tomorrow: Leveraging Digital Health to Move toward Health for All.

This series of papers explores the concept of essential digital health for the underserved. Several cross-cutting themes are highlighted in this paper, for example: (1) harmonizing journeys of different patient groups to understand diverse perspectives; (2) engaging health professionals in interoperability, change management and health human resource capacity building; (3) ensuring harmonization of micro, meso and macro levels of health services delivery; and (4) integrating evaluation iteratively to enable continuous improvement and learning. Adopting a learning health system (LHS) approach facilitates iterative growth and evolution, incorporating concepts from the software industry, as well as participatory processes such as failing forward, developing ecosystems for collaboration and engagement of stakeholders. The example of HealthLink BC's 811 as a digital front door is used to demonstrate how an LHS approach can enable meaningful system change. We welcome further dialogues and discussion on existing and emerging examples of health system implementation approaches that can help our Canadian health systems move continuously and progressively closer toward the ultimate goal of Health for All (WHO 2023).

Implementing digital emergency medicine: a call to action.

As digital technologies continue to impact medicine, emergency medicine providers have an opportunity to work together to harness these technologies and shape their implementation within our healthcare system. COVID-19 and the rapid scaling of virtual care provide an example of how profoundly emergency medicine can be affected by digital technology, both positively and negatively. This example also strengthens the case for why EM providers can help lead the integration of digital technologies within our broader healthcare system. As virtual care becomes a permanent fixture of our system, and other technologies such as AI and wearables break into Canadian healthcare, more advocacy, research, and health system leadership will be required to best leverage these tools. This paper outlines the purpose and outputs of the newly founded CAEP Digital Emergency Medicine (DigEM) Committee, with the hope of inspiring further interest amongst CAEP members and creating opportunities to collaborate with other organizations within CAEP and across EM groups nationwide.

Defining "Essential Digital Health for the Underserved".

The World Health Organization envisions achieving "Health for All," to strive for equitable access to important health information and services to attain wellness (WHO 2023a). The COVID-19 pandemic reshaped the Canadian health system toward increasing digital health services, which improved access for some but underserved others. Integrating digital health into holistic health services delivery deserves careful consideration. This paper introduces the concept of "essential digital health for the underserved," by first defining the terms "digital health," "essential" and "underserved." Then, we share a summary of a discussion at a May 2023 conference with stakeholders, including patients, caregivers, health professionals, health policy makers, private sectors and health researchers. A series of papers follow to explore how digital health can help chart a responsible course for the future of essential digital health in Canada. In this post-pandemic era - with a health human resources shortage through attrition and retirement, an increased health service demand from patients and a greater strain on our recovering economy - innovative solutions need to be implemented to strengthen our Canadian health system.

Trustworthy Evidence to Support Quality Digital Healthcare Policy for Underserved Communities: What Needs to Happen to Translate Evidence into Policy?

In this paper, we explore what is needed to generate quality research to guide evidence-informed digital health policy and call the Canadian community of patients, clinicians, policy (decision) makers and researchers to action in setting digital health research priorities for supporting underserved communities. Using specific examples, we describe how evidence is produced and implemented to guide digital health policy. We study how research environments must change to reflect and include the communities for whom the policy is intended. Our goal is to guide how future evidence reaches policy makers to help them shape healthcare services and how these services are delivered to underserved communities in Canada. Understanding the pathways through which evidence can make a difference to equitable and sustainable digital health policy is vital for guiding the types of research that attract priority resources.