Digital health literacy and the ethics of information access: a systematic review of global trends, equity challenges and policy responses

Purpose Digital health literacy has emerged as a critical determinant of equitable healthcare delivery in the information society. This study aims to examine evolving trends, thematic patterns and ethical considerations, with a focus on global policy responses and technological developments in 2023–2025. Design/methodology/approach A systematic literature review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventy-two studies published between 2015 and 2025 (with a small number of earlier studies retained due to their continued conceptual and ethical relevance) were selected through database searches (PubMed, Scopus, Web of Science) and manual reference checks. Data were extracted and synthesised thematically, integrating recent policy documents and conceptual analyses relevant to ethics and equity. Findings Five dominant themes emerged: access and infrastructure inequities; misinformation and infodemic management; usability and user-centred design; health data poverty; and ethical governance. While digital health tools proliferated globally, disparities in access, representation and trust remain significant. Developments from 2023 to 2025 (e.g. artificial intelligence-driven health chatbots, TikTok-based health campaigns and updated World Health Organization infodemic guidelines) not only offer opportunities but also introduce new risks. Research limitations/implications The findings position digital health literacy as a core ethical construct within information systems and health policy scholarship, extending digital divide theory beyond access and skills to include justice, autonomy and data representation. This reframing underscores the need to integrate ethical governance and power asymmetries into models of digital health adoption. Practical implications Policymakers and health system designers should embed equity-by-design principles into digital health initiatives, prioritising inclusive usability, misinformation mitigation and representative data practices. Co-ordinated regulatory frameworks and targeted literacy interventions are essential to ensure emerging digital health technologies reduce, rather than reproduce, health inequalities. Originality/value This systematic review contributes to the discourse on information ethics in healthcare by explicitly linking digital health literacy to principles of justice, autonomy and beneficence. It offers a comprehensive synthesis that is policy-oriented, globally comparative and grounded in the latest literature.