A Digital Health Equity Framework for Sustainable e-Health Services in Saudi Arabia

Fahdah AlShaikh () and Rawan Hayan Alwadai
Additional contact information
Fahdah AlShaikh: Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh P.O. Box 11433, Saudi Arabia
Rawan Hayan Alwadai: Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh P.O. Box 11433, Saudi Arabia

Sustainability, 2025, vol. 17, issue 17, 1-23

Abstract: As Saudi Arabia accelerates digital transformation under Vision 2030, the sustainable adoption of Health 4.0 technologies depends on equitable digital health literacy (DHL) and population-level readiness for eHealth engagement. Despite growing interest, empirical data on the behavioral, social, and contextual determinants of digital health adoption remain limited in Middle Eastern settings. This study investigates the readiness of Saudi adults for eHealth services, identifies key behavioral factors influencing digital tool adoption, and proposes an equity-centered, network-aware DHL framework to support inclusive and sustainable Health 4.0 implementation. A multi-phase, cross-sectional study was conducted among 430 Saudi adults using validated instruments including eHEALS, TRI 2.0, UTAUT, and EQ-5D. Quantitative analysis employed multiple linear regression (R 2 = 0.79), structural equation modeling (CFI = 0.96; RMSEA = 0.04), social network analysis (centrality scores), and network-based diffusion analysis (s = 0.17). Additionally, a three-round Delphi method (CI ≤ 0.25) ensured expert consensus on framework development. Significant predictors of digital health tool adoption included eHealth readiness (β = 0.18), perceived usability, and system trust. Social network metrics identified central actors who facilitated peer-driven behavioral diffusion, validated through NBDA modeling. Based on these findings, a comprehensive DHL Equity Framework was synthesized, integrating behavioral drivers, network diffusion pathways, and principles from the Triple Bottom Line (TBL) framework to mitigate structural disparities while addressing environmental, economic, and social dimensions of sustainable digital health access. The framework was also systematically mapped to relevant Sustainable Development Goals (SDGs), highlighting its alignment with global health and sustainability targets. This study presents a scalable and policy-relevant model to guide inclusive eHealth strategies in Saudi Arabia and similar developing contexts. The proposed framework advances national digital resilience, reduces inequities, and promotes sustainable Health 4.0 service delivery.

Keywords: digital health literacy; eHealth readiness; Health 4.0; structural equation modeling; network diffusion (search for similar items in EconPapers)
JEL-codes: O13 Q Q0 Q2 Q3 Q5 Q56 (search for similar items in EconPapers)
Date: 2025
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
https://www.mdpi.com/2071-1050/17/17/7681/pdf (application/pdf)
https://www.mdpi.com/2071-1050/17/17/7681/ (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:gam:jsusta:v:17:y:2025:i:17:p:7681-:d:1732937

Access Statistics for this article

Sustainability is currently edited by Ms. Alexandra Wu

More articles in Sustainability from MDPI
Bibliographic data for series maintained by MDPI Indexing Manager ().