TY - JOUR T1 - Socioeconomic Inequalities in Digital Health in Türkiye: An OECD-Based Qualitative Analysis TT - Türkiye'de Dijital Sağlıkta Sosyoekonomik Eşitsizlikler: OECD Tabanlı Nitel Bir Analiz AU - Kocaman, Ersin PY - 2025 DA - October Y2 - 2025 DO - 10.54733/smar.1763964 JF - Sosyal Mucit Academic Review JO - SMAR PB - Erhan AYDIN WT - DergiPark SN - 2718-1081 SP - 53 EP - 75 VL - 6 IS - Global Academic Perspective in Social Sciences LA - en AB - The aim of this study is to determine how socioeconomic inequalities affect digital health across different population groups in Türkiye. A qualitative research approach using document analysis was adopted in the study. The official report “OECD Economic Survey: Türkiye 2025” was selected as the main analysis source. Data analysis was conducted using content analysis using MAXQADA 2024 Analytics Pro and Microsoft Excel software programs. 5 themes, 15 categories and 24 codes were generated for the study regarding socioeconomic determinants that may affect digital health. Five main areas affecting digital health were identified, focusing on socioeconomic inequality: income inequality and limited redistribution, structural barriers to women's labor force participation, lifelong learning and skills, limited diffusion of technology adoption and innovation and key socioeconomic indicators. International comparisons indicate that similar barriers exist in other countries with high socioeconomic inequality. By evaluating the OECD Economic Survey: Türkiye 2025 with a qualitative approach, the study offers an original contribution to the literature on how socioeconomic inequalities affect the digital health transformation in Türkiye. The study's conclusions highlight the need to reform the tax and transfer system, develop gender-based social programs, expand access to digital skills training, foster innovation and increase public investment in healthcare. Implementing these strategies will increase the comprehensiveness of digital health services, narrow the digital divide and ensure a more equitable distribution of technological benefits across the population. KW - digital health KW - socioeconomic inequality KW - OECD KW - Türkiye KW - qualitative research N2 - Bu çalışmanın amacı Türkiye'de sosyoekonomik eşitsizliklerin farklı nüfus grupları için dijital sağlığı nasıl etkilediğini belirlemektir. Çalışmada, doküman incelemesi yönteminin kullanıldığı nitel bir araştırma yaklaşımı benimsenmiştir. “OECD Ekonomik Araştırmaları: Türkiye 2025” resmi raporu temel analiz kaynağı olarak seçilmiştir. İçerik analizi yöntemi ile gerçekleştirilen veri analizinde MAXQADA 2024 Analytics Pro ve Microsoft Excel yazılım programları kullanılmıştır. Çalışmada, dijital sağlığı etkileyebilecek sosyoekonomik belirleyicilere ilişkin 5 tema 15 kategori ve 24 kod oluşturulmuştur. Gelir eşitsizliği ve sınırlı yeniden dağıtım, kadınların işgücüne katılımında yapısal engeller, yaşam boyu öğrenme ve beceriler, teknoloji benimsemesi ve inovasyonun sınırlı yayılımı ve temel sosyoekonomik göstergeler sosyoekonomik eşitsizlik odağında dijital sağlığı etkileyen beş ana alan olarak belirlenmiştir. Uluslararası karşılaştırmalar benzer engellerin, yüksek sosyoekonomik eşitsizliğe sahip diğer ülkelerde de bulunduğunu göstermektedir. OECD Ekonomik Araştırması: Türkiye 2025'i nitel bir yaklaşımla değerlendiren çalışma, sosyoekonomik eşitsizliklerin Türkiye'de dijital sağlık dönüşümünü nasıl etkilediği konusunda literatüre özgün bir katkı sunmaktadır. Çalışma sonuçları, vergi ve transfer sistemi reformu, cinsiyete dayalı sosyal programların geliştirilmesi, dijital beceri eğitimine erişimin genişletilmesi, inovasyonun teşvik edilmesi ve sağlık hizmetlerine kamu yatırımlarının artırılması gerektiğini vurgulamaktadır. Bu stratejilerin uygulanması, dijital sağlık hizmetlerinin kapsayıcılığını artıracak, dijital uçurumu azaltacak ve teknolojik faydaların nüfus arasında daha adil dağıtılmasını sağlayacaktır. CR - Agwenyi, C. A., & Wabwoba, F. (2024). The deepening digital divide: Inequality in the information society. International Journal of Science and Research Archive, 13(2), 2664-2667. https://doi.org/10.30574/ijsra.2024.13.2.2105 CR - Alvarez-Galvez, J., Salinas-Perez, J. A., Montagni, I., & Salvador-Carulla, L. (2020). The persistence of digital divides in the use of health information: A comparative study in 28 European countries. International Journal of Public Health, 65(3), 325-333. https://doi.org/10.1007/s00038-020-01363-w CR - Amber, H., & Chichaibelu, B. B. (2023). Narrowing the gender digital divide in Pakistan: Mobile phone ownership and female labor force participation. Review of Development Economics, 27(3), 1354-1382. https://doi.org/10.1111/rode.12994 CR - Armstrong, C. (2021). Key methods used in qualitative document analysis. SSRN Electronic Journal. https://dx.doi.org/10.2139/ssrn.3996213 CR - Ashwini L. H., Vinaykumar L. H., & Hanumanaik L. (2024). Evaluating the impact of digital health technologies on public health outcomes: a global perspective. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 237-248. https://doi.org/10.53555/emt7nf68 CR - Azzopardi, D., Fareed, F., Lenain, P., & Sutherland, D. (2019). Assessing household financial vulnerability: Empirical evidence from the US using machine learning. In D. Sutherland (Ed.), OECD economic survey of the United States: Key research findings (pp. 121-142). OECD Publishing. https://doi.org/10.1787/9789264310278-en CR - Azzopardi-Muscat, N., & Sørensen, K. (2019). Towards an equitable digital public health era: Promoting equity through a health literacy perspective. European Journal of Public Health, 29(Supplement_3), 13-17. https://doi.org/10.1093/eurpub/ckz166 CR - Babitsch, B., Gohl, D., & von Lengerke, T. (2012). Re-revisiting Andersen’s behavioral model of health services use: A systematic review of studies from 1998–2011. GMS Psycho-Social-Medicine, 9, Doc11. https://doi.org/10.3205/psm000089 CR - Badr, J., Motulsky, A., & Denis, J. L. (2024). Digital health technologies and inequalities: A scoping review of potential impacts and policy recommendations. Health Policy, 146, 105122. https://doi.org/10.1016/j.healthpol.2024.105122 CR - Bonomi, S., Cristofaro, C. L., De Simone, S., Georges Badr, N., & Ventura, M. (2023). Special issue: Innovation development and digital technologies for sustainable healthcare ecosystems Mecosan: Management ed Economia Sanitaria, 125(1), 7-10. https://doi.org/10.3280/mesa2023-125oa16832 CR - Bowen, G. A. (2009). Document analysis as a qualitative research method. Qualitative Research Journal, 9(2), 27-40. https://doi.org/10.3316/QRJ0902027 CR - Campbell, S., Greenwood, M., Prior, S., Shearer, T., Walkem, K., Young, S., Bywaters, D., & Walker, K. (2020). Purposive sampling: Complex or simple? Research case examples. Journal of research in Nursing, 25(8), 652-661. https://doi.org/10.1177/1744987120927206 CR - Canton, H. (2021). United Nations entity for gender equality and the empowerment of women—UN women. In E. Publications (Ed.), The Europa directory of international organizations 2021 (Twenty-third edition, pp. 185-187). Routledge. https://doi.org/10.4324/9781003179900 CR - Cardno, C. (2018). Policy document analysis: A practical educational leadership tool and a qualitative research method. Educational Administration: Theory & Practice, 24(4), 623-640. CR - Carrera, E. J. S., Rombaldoni, R., & Pozzi, R. (2021). Socioeconomic inequalities in Europe. Economic Analysis and Policy, 71, 307-320. https://doi.org/10.1016/j.eap.2021.05.007 CR - Carrilho, J., Videira, D., Campos, C., Midão, L., & Costa, E. (2023). Changing the paradigm in health and care services: Modern value chains using open innovation for the creation of new digital health solutions. Frontiers in Digital Health, 5, 1216357. https://doi.org/10.3389/fdgth.2023.1216357 CR - Deganis, I., Zohouri Haghian, P., Tagashira, M., & Alberti, A. (2021). Leveraging digital technologies for social inclusion (Policy Brief No. 92). United Nations Department of Economic and Social Affairs. CR - do Nascimento, I. J. B., Abdulazeem, H. M., Weerasekara, I., Marquez, J., Vasanthan, L. T., Deeken, G., Morgan, R., Tan, H. L., Aguirre, I. Y., Østeengaard, L., Kularathne, I., Azzopardi-Muscat, N., van Kessel, R., Martinez, E. Z., Permanand, G., & Novillo-Ortiz, D. (2025). Transforming women's health, empowerment, and gender equality with digital health: Evidence-based policy and practice. The Lancet Digital Health, 7(6), 100858. https://doi.org/10.1016/j.landig.2025.01.014 CR - Égert, B., & Gal, P. (2017). The quantification of structural reforms in OECD countries: A new framework (No. 2017-15). University of Paris Nanterre, EconomiX. CR - Elantheraiyan, P., Panda, S., Patil, A. K., Ramanjaneyulu, R., Narawade, N., & Pougajendy, S. (2025). Advancing digital health literacy: Integrating public health, educational strategies and technological innovations for equitable access and empowerment. Revista Latinoamericana de la Papa, 29(1), 464-476. CR - Erfani, G., McCready, J., Gibson, B., Nichol, B., Unsworth, J., Jarva, E., Mikkonen, K., & Tomietto, M. (2025). Factors influencing digital health competence among healthcare professionals: A cross-sectional study. Applied Nursing Research, 82, 151922. https://doi.org/10.1016/j.apnr.2025.151922 CR - Estrela, M., Semedo, G., Roque, F., Ferreira, P. L., & Herdeiro, M. T. (2023). Sociodemographic determinants of digital health literacy: A systematic review and meta-analysis. International Journal of Medical Informatics, 177, 105124. https://doi.org/10.1016/j.ijmedinf.2023.105124 CR - Fernandes, F. A., Chaltikyan, G., Adib, K., Caton-Peters, H., & Novillo-Ortiz, D. (2024). The role of governance in the digital transformation of healthcare: Results of a survey in the WHO Europe Region. International Journal of Medical Informatics, 189, 105510. https://doi.org/10.1016/j.ijmedinf.2024.105510 CR - Gabriel, F., Marrone, R., Van Sebille, Y., Kovanovic, V., & de Laat, M. (2022). Digital education strategies around the world: Practices and policies. Irish Educational Studies, 41(1), 85-106. https://doi.org/10.1080/03323315.2021.2022513 CR - Garcia, R. (2023). Social determinants of health. In F. A. Gary & M. J. Lotas (Eds.), A population health approach to health disparities for nurses: Care of vulnerable populations (pp. 107-130). Springer. https://doi.org/10.1891/9780826185044.0006 CR - Gedikli, E., (2024). Future digital health trends. Y. D. Uslu, & H. Zülfikar (Eds.), Digitalization in health (pp. 181-191). Istanbul University Press. https://doi.org/10.26650/B/LSB40.2024.035 CR - Giebel, G. D., Speckemeier, C., Abels, C., Plescher, F., Börchers, K., Wasem, J., Blase, N., & Neusser, S. (2023). Problems and barriers related to the use of digital health applications: scoping review. Journal of Medical Internet Research, 25, e43808. https://doi.org/10.2196/43808 CR - Hahn, R. A. (2021). What is a social determinant of health? Back to basics. Journal of Public Health Research, 10(4). https://doi.org/10.4081/jphr.2021.2324 CR - Haight, M., Quan-Haase, A., & Corbett, B. A. (2014). Revisiting the digital divide in Canada: The impact of demographic factors on access to the internet, level of online activity, and social networking site usage. Information, Communication & Society, 17(4), 503-519. https://doi.org/10.1080/1369118X.2014.891633 CR - Heponiemi, T., Kaihlanen, A. M., Virtanen, L., Kainiemi, E., Saukkonen, P., Koponen, P., Koskinen, S., & Elovainio, M. (2024). The mediating role of digital competence in the associations between the factors affecting healthcare utilization and access to care. International Journal of Public Health, 68, 1606184. https://doi.org/10.3389/ijph.2023.1606184 CR - Holt-Lunstad, J. (2022). Social connection as a public health issue: The evidence and a systemic framework for prioritizing the “social” in social determinants of health. Annual Review of Public Health, 43, 193-213. https://doi.org/10.1146/annurev-publhealth-052020-110732 CR - Hudes, M. K. (2017). Fostering innovation in digital health a new ecosystem. In 2017 Pan Pacific Microelectronics Symposium (Pan Pacific) (pp. 1-6). IEEE. CR - Ibrahim, H., Liu, X., Zariffa, N., Morris, A. D., & Denniston, A. K. (2021). Health data poverty: An assailable barrier to equitable digital health care. The Lancet Digital Health, 3(4), e260-e265. https://doi.org/10.1016/S2589-7500(20)30317-4 CR - Inayah., & Maghfiroh, D. (2025). Gender, technology, and the world of work: Exploring the digital divide among female workers. INJURITY: Journal of Interdisciplinary Studies, 4(2), 118-125. https://doi.org/10.58631/injurity.v4i2.1422 CR - Inoue, E., Taniguchi, H., & Yamada, K. (2022). Measuring energy-saving technological change: International trends and differences. Journal of Environmental Economics and Management, 115, 102709. https://doi.org/10.1016/j.jeem.2022.102709 CR - Iyawa, G. E., Herselman, M., & Botha, A. (2017). A scoping review of digital health innovation ecosystems in developed and developing countries. In 2017 IST-Africa Week Conference (IST-Africa) (pp. 1-10). IEEE. https://doi.org/10.23919/ISTAFRICA.2017.8102325 CR - Jahnel, T., Dassow, H. H., Gerhardus, A., & Schüz, B. (2022). The digital rainbow: Digital determinants of health inequities. Digital Health, 8. https://doi.org/10.1177/20552076221129093 CR - Jun, W. (2020). A study on the current status and improvement of the digital divide among older people in Korea. International Journal of Environmental Research and Public Health, 17(11), 3917. https://doi.org/10.3390/ijerph17113917 CR - Karakuzu, B., & Şengül, S. (2024). Türkiye’de sağlık eşitsizliğinin sosyoekonomik belirleyicileri. Üçüncü Sektör Sosyal Ekonomi Dergisi, 59(4), 3222-3243. https://doi.org/10.15659/3.sektor-sosyal-ekonomi.24.12.2516 CR - Kılıç, S. (2015). Kappa testi. Journal of Mood Disorders, 5(3), 142-144. https://doi.org/10.5455/jmood.20150920115439 CR - Konca, M., Demirci, Ş., Çakmak, C., & Uğurluoğlu, Ö. (2022). Exploring the socio-economic determinants of health information-seeking behaviour on the internet in Turkey. Information Research, 27(2). https://doi.org/10.47989/irpaper930 CR - Lederle, M., Tempes, J., & Bitzer, E. M. (2021). Application of Andersen’s behavioural model of health services use: A scoping review with a focus on qualitative health services research. BMJ open, 11(5), e045018. https://doi.org/10.1136/bmjopen-2020-045018 CR - Longhini, J., Rossettini, G., & Palese, A. (2024). Digital health competencies and affecting factors among healthcare professionals: Additional findings from a systematic review. Journal of Research in Nursing, 29(2), 156-176. https://doi.org/10.1177/17449871241226899 CR - Ministry of Health of the Republic of Türkiye. (MH). (2023). Sağlık Bakanlığı Stratejik Planı 2024–2028. Ministry of Health of the Republic of Türkiye. https://dosyamerkez.saglik.gov.tr/Eklenti/47452/0/saglik-bakanligi-stratejik-plan-2024-2028pdf.pdf?_tag1=7B2A9834832BF7DCF36F2C7E5607D8543752A372 (Accessed Date: 4 October 2025). CR - Mumtaz, H., Riaz, M. H., Wajid, H., Saqib, M., Zeeshan, M. H., Khan, S. E., Chauhan, Y. S., Sohail, H., & Vohra, L. I. (2023). Current challenges and potential solutions to the use of digital health technologies in evidence generation: A narrative review. Frontiers in Digital Health, 5, 1203945. https://doi.org/10.3389/fdgth.2023.1203945 CR - Nosike, C. J. (2024). Digitalization in developing countries: Opportunities and challenges. Niger. Nigerian Journal of Arts and Humanities (NJAH), 4(1), 1-11. CR - OECD. (2023). Health at a glance 2023: OECD indicators. OECD Publishing. https://doi.org/10.1787/7a7afb35-en CR - OECD. (2025a). Economic surveys. OECD. https://www.oecd.org/en/topics/economic-surveys.html (Accessed Date: 10 August 2025). CR - OECD. (2025b). Türkiye economic snapshot. OECD. https://www.oecd.org/en/topics/sub-issues/economic-surveys/turkiye-economic-snapshot.html (Accessed Date: 10 August 2025). CR - OECD. (2025c). OECD economic surveys: Türkiye 2025. OECD. https://www.oecd.org/en/publications/oecd-economic-surveys-turkiye-2025_d01c660f-en.html (Accessed Date: 10 August 2025). CR - Oliveira Hashiguchi, T. (2020). Bringing health care to the patient: An overview of the use of telemedicine in OECD countries (OECD Health Working Papers, No. 116). OECD Publishing. https://doi.org/10.1787/8e56ede7-en CR - Resmi Gazete. (2025). Devlet memurlarının yarım zamanlı çalışma hakkının kullanımına ilişkin yönetmelik. Resmi Gazate (Sayı: 32959). https://www.resmigazete.gov.tr/eskiler/2025/07/20250718-24.pdf (Accessed Date: 10 August 2025). CR - Shotarova, Z. (2023). Leveraging technology to enhance healthcare access: Lessons from European leaders and challenges in Bulgaria. Journal of Management Sciences and Applications (JOMSA), 2(1), 169-174. CR - Tunçsiper, Ç. (2025). Bridging the digital divide with gender equity in the digital world: Empirical insights from OECD countries. Journal of Work-Applied Management. https://doi.org/10.1108/JWAM-08-2024-0119 CR - Ubalaeze, S. E., Kelechi, W. E., Erere, G. O., Chinemerem, D. A., & Chioma, S. N. (2025). The impact of digital transformation on healthcare delivery in Nigeria: Challenges and recommendations. International Journal of Research and Scientific Innovation, 11(15), 498-509. https://doi.org/10.51244/IJRSI.2024.11150035P CR - van de Vijver, S., Tensen, P., Asiki, G., Requena-Méndez, A., Heidenrijk, M., Stronks, K., Cobelens, F., Bont, J., & Agyemang, C. (2023). Digital health for all: How digital health could reduce inequality and increase universal health coverage. Digital Health, 9. https://doi.org/10.1177/20552076231185434 CR - van Dijk, J. (2017). Afterword: The state of digital divide theory. In M. Ragnedda & G. W. Muschert (Eds.), Theorizing digital divides (First edition, pp. 199-206). Routledge. https://doi.org/10.4324/9781315455334-16 CR - Wang, J., & Xu, Y. (2023). Digitalization, income inequality, and public health: Evidence from developing countries. Technology in Society, 73, 102210. https://doi.org/10.1016/j.techsoc.2023.102210 CR - World Health Organization, & United Nations Children's Fund. (2022). Protect the promise: equal access and opportunity for every woman, child and adolescent. 2022 progress report on every woman every child global strategy for women’s, children’s and adolescents’ health (2016–2030). World Health Organization and the United Nations Children's Fund (UNICEF). CR - World Health Organization. (WHO). (2021). Global strategy on digital health 2020–2025. World Health Organization. https://www.who.int/docs/default-source/documents/gs4dhdaa2a9f352b0445bafbc79ca799dce4d.pdf (Accessed Date: 4 October 2025). CR - Yao, R., Zhang, W., Evans, R., Cao, G., Rui, T., & Shen, L. (2022). Inequities in health care services caused by the adoption of digital health technologies: Scoping review. Journal of Medical Internet Research, 24(3), e34144. https://doi.org/10.2196/34144 CR - Yıldırım, A., & Şimşek, H. (2021). Sosyal bilimlerde nitel araştırma yöntemleri (On ikinci baskı). Seçkin Yayıncılık. CR - Yılmaz, E. (2024). Mobile health application. Y. D. Uslu, & H. Zülfikar (Eds.), Digitalization in health (pp. 48-61). Istanbul University Press. https://doi.org/10.26650/B/LSB40.2024.035 CR - Zhang, D., Zhang, G., Jiao, Y., Wang, Y., & Wang, P. (2022). “Digital dividend” or “digital divide”: What role does the internet play in the health inequalities among Chinese residents?. International Journal of Environmental Research and Public Health, 19(22), 15162. https://doi.org/10.3390/ijerph192215162 UR - https://doi.org/10.54733/smar.1763964 L1 - https://dergipark.org.tr/en/download/article-file/5149439 ER -