Equity Implications of Digital Health Interventions for Chronic Disease Management in Rural and Urban Nigeria: A Comparative Health Systems Analysis

Background: Digital health interventions offer transformative potential for chronic disease management but may widen health equity gaps if implementation does not account for differential access, digital literacy, and socioeconomic contexts. This study analyses the equity implications of digital health implementation for chronic disease management across rural and urban settings in Nigeria. Methodology: A comparative health systems analysis was conducted using primary data from 12 digital health programme sites across five geopolitical zones and secondary analysis of national health survey datasets. An equity-focused implementation science framework guided analysis. Twenty-four key informant interviews with programme implementers and policymakers complemented quantitative data. Results: Urban digital health programme beneficiaries showed significantly greater improvement in chronic disease outcomes compared to rural participants due to infrastructure differentials. Older adults, women, and lower-literacy users were systematically less likely to engage with digital platforms. Programmes incorporating low-technology elements such as SMS and community health worker-mediated digital tools demonstrated more equitable reach. Conclusion: Digital health implementation for chronic disease management in Nigeria risks exacerbating existing health equity divides unless equity-centred design principles are embedded from programme inception. Family medicine departments should lead advocacy for equity audits in digital health programmes and champion low-bandwidth community-delivered models. Keywords: digital health, equity, chronic disease, rural-urban, Nigeria