As hospitals and healthcare systems increasingly shift patient communication, care management and health information online, researchers are asking a critical question: who gets left behind when digital tools are not designed for everyone?
Those challenges and the risks of widening disparities through poorly designed technology will be a central focus at the 2026 Americal Medical Informatics Association (AMIA) Amplify Conference, where Samantha Stonbraker, PhD, MPH, RN, FAAN, FAMIA associate professor in the Division of Behavioral, Family, & Population Health at the University of Colorado Anschutz College of Nursing, will present on the panel, “From Frameworks to Implementation: Advancing Digital Health Equity Across the Technology Lifecycle.”
Stonbraker’s research focuses on designing digital health tools that are usable and effective for populations with varying levels of digital and health literacy, particularly groups experiencing vulnerability.
“I define digital literacy as the ability to access and meaningfully use digital tools and platforms, while health literacy refers to the capacity to obtain, process, and act on health information,” said Stonbraker.
Building Digital Health Tools for Real-World Users
Rather than focusing on measuring literacy levels and trying to tailor communication or system design to those specific levels, she emphasizes designing systems that work for a broad range of users from the beginning.
“Historically, I have measured health literacy with several different validated tools such as the Short Assessment of Health Literacy – Spanish & English,” added Stonbraker. “But, I don’t think measuring either digital, or health, literacy is as useful as leveraging universal digital and health literacy precautions in the design process and closely collaborating with potential end users on system design and evaluation. This ensures the people who need to use systems and tools we are making actually can.”
Her research uses mixed-methods approaches and recruits both patients and healthcare providers to evaluate whether digital health tools are acceptable, useful and usable across digital and health literacy levels.
Why Literacy-Responsive Design Matters
“My work in developing mobile applications and web-based tools for vulnerable populations has demonstrated that literacy-responsive design meaningfully improves usability and engagement among users with low digital or health literacy,” emphasized Stonbraker.
In one study, infographics designed to support clinical communication improved HIV-related knowledge and viral load outcomes, illustrating how tailored visual tools can influence health outcomes.
“A clinically significant result that illustrates how thoughtfully tailored visual tools can translate into improvements in health outcomes,” shared Stonbraker. “These findings align with a broader body of evidence indicating that one-size-fits-all digital health tools systematically underperform for populations with lower literacy, and that intentional design can close that gap.”
Addressing Disparities Across the Technology Lifecycle
According to Stronbraker, disparities can emerge at every stage of the technology lifecycle, from design and implementation to evaluation. Technologies built without direct input from intended users may unintentionally rely on assumptions about device familiarity, broadband access or prior knowledge that do not reflect the realities of all populations.
Designing With Communities, Not Just for Them
User-centered and participatory design methods remain central to Stonbraker’s process. Intended users are involved throughout design and evaluation through interviews, iterative design sessions, and prototype testing.
“Target populations must be meaningfully involved in digital tool creation from the earliest stages of design through final evaluation and implementation,” said Stonbraker. “In line with this, tools must be iteratively and rigorously evaluated with and for those with low digital or health literacy, not simply adapted to them after the fact.”
She went on to add, “My research demonstrates that this investment pays off as several of my studies show that the tools we develop are desired and usable by the populations they are meant to benefit.”
Looking Beyond Access to Long-Term Usability
Stonbraker said the work will ultimately points to the importance of building digital health technologies alongside the communities they are intended to serve, while also addressing barriers such as device access, internet connectivity and digital support systems to ensure tools remain accessible and sustainable for long-term use.
