Beyond Access: A Multi-domain Framework for Assessing Digital Health Underutilisation in Non-communicable Disease Care in Low- and Middle-Income Countries

Digital-health technologies are increasingly being incorporated into the management of non-communicable diseases (NCDs); however, meaningful utilisation remains inconsistent in many low- and middle-income countries (LMICs) despite expanding digital infrastructure and telemedicine availability. Existing literature has largely focused on disease-specific interventions or individual digital-health tools, while structured, implementation-oriented frameworks for assessing digital-health underutilisation across diverse NCD settings remain limited. This technical report presents a practical multi-domain framework for assessing digital-health underutilisation in NCD care within LMIC settings. The framework conceptualises utilisation as a multidimensional process influenced by structural access, individual capability, behavioural readiness, and health-system factors. It incorporates assessment domains related to device and internet access, digital and eHealth literacy, attitudes toward digital-health use, contextual barriers, and integration within routine healthcare pathways. The report additionally outlines a stepwise implementation workflow intended to support structured assessment across outpatient, community, and chronic disease-care settings. The framework was informed by practical operational experience derived from structured outpatient digital-health assessment implemented within a tertiary-care setting in Southern India and is designed to remain adaptable across a broader range of NCD-care environments. Digital-health underutilisation in LMICs reflects a complex interaction of technological, behavioural, literacy-related, and health-system determinants rather than limitations in access alone. The framework presented in this report provides a practical and reproducible implementation-oriented approach for systematically evaluating barriers to digital-health utilisation and may support context-sensitive strategies for strengthening digital-health integration within NCD care.