Multidimensional Digital Inequality in Rural and Urban District Hospitals in Ghana: Implications for Health Equity

Abstract Background Digital health technologies are increasingly deployed to strengthen healthcare delivery in low- and middle-income countries, yet unequal access to the material resources, skills and opportunities required for meaningful use may reproduce existing inequalities. Evidence on provider-level digital inequality between rural and urban healthcare settings in sub-Saharan Africa remains limited. This study examined rural-urban differences in multidimensional digital health access among healthcare workers in Ghana's public district hospitals. Methods A comparative cross-sectional survey was conducted among 384 healthcare workers from 20 public district hospitals, comprising 10 rural and 10 urban hospitals. Structured questionnaires measured motivational, material, skills and usage access, and perceived digital health benefits. Rural-urban differences were assessed using independent-samples t-tests, with Mann-Whitney U tests as sensitivity analyses. Partial least squares structural equation modelling examined associations among access dimensions and perceived benefits. Results Motivational access did not differ significantly between rural and urban respondents (2.87 vs. 2.99, p = .201). Significant differences were observed in material access (2.25 vs. 3.47, p < .001, d = 1.74), skills access (2.69 vs. 3.23, p < .001, d = 0.69), usage access (2.55 vs. 3.20, p < .001, d = 0.85) and perceived digital health benefits (2.71 vs. 3.10, p < .001, d = 0.52). Material access was positively associated with skills access (β = 0.513, p < .001) and usage access (β = 0.282, p = .003), while skills access was positively associated with usage access (β = 0.362, p < .001). Usage access had the strongest direct association with perceived benefits (β = 0.548, p < .001). Skills access was not directly associated with perceived benefits (β = −0.050, p = .592). Conclusions Rural-urban digital inequality extends beyond connectivity to encompass material resources, digital skills, patterns of technology use and perceived benefits. The findings suggest that equitable digital transformation requires attention to the conditions that enable healthcare workers to develop capabilities and translate digital access into meaningful use. Addressing multidimensional provider-level inequality may therefore represent an important upstream consideration for digital health equity in Ghana and comparable low- and middle-income health systems.