Table 3.

Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) summary of findings.

Summary of review findings	Studies contributing to the review findings	Methodological limitations	Coherence	Adequacy	Relevance	CERQual assessment of confidence	Explanation of CERQual assessment
Low household income, older age, and ethnic minority background (especially limited-English speakers) were all independently associated with lower uptake of video consultations.	Fu et al [5] Moher et al [47] Parker et al [48] Litchfield et al [49] Eberly et al [70] Rodriguez et al [56] Zachrison et al [62] Stevens et al [51] Donaghy et al [55] Ramsetty et al [63] Thronson et al [65] Gray et al [67] Eruchalu et al [68] Mehmi et al [64] Ramasawmy et al [66]	Some concerns about reflexivity [47-49,51,55,63-66, 70], recruitment [5,49,55,65-68,70], and analytical rigor [5,47-49,56,63,64, 67,70]	No concerns—strongly evidenced with qualitative or quantitative data	No concerns [49,51,62,64,67,68] Minor concerns [5,47,48,55,56, 63,65] Moderate concerns [66,70]	No concerns [5,47,49,51,55, 56, 63-68] Minor concerns [48,51,62,70]	High confidence	15 studies contributing data with good coherence and few other concerns
Research into digital health disparities, at least in relation to video consultations, has to date been almost entirely descriptive rather than explanatory.	All studies	Some concerns about reflexivity [47-49,64,65,67, 68,70], recruitment [5,49,56,57, 70], analytical rigor [5,47,48,56,61,63, 66,70], and ethical considerations [56]	No concerns	No concerns [49,51,57,62, 64,65] Minor concerns [5,47,48,55,56, 61,66,68] Moderate concerns [63,67,70]	No concerns	High confidence	All studies contributing data with good coherence and few other concerns
The higher the patient’s social vulnerability index, the more likely the consultation occurred by phone instead of video.	Eberly et al [70] Thronson et al [65] Eruchalu et al [68] Mehmi et al [64] Ramasawmy et al [66]	Some concerns about analytical rigor, recruitment, and reflexivity [64,66,68]	No concerns [64-66,68] Minor concerns—limited sample size and not explored in detail in the study [70]	No concerns [64-66,68] Moderate concerns—limited sample size, not sufficiently “rich” data [70]	No concerns [64-66,68] Minor concerns [70]	High confidence	Only one study contributing data with moderate concerns about sample size
Access to digital health services is hampered by insufficient digital or local language skills.	Parker et al [48] Rodriguez et al [56] Hsueh et al [57] Zachrison et al [62] Donaghy et al [55] Ramsetty et al [63] Thronson et al [65] Gray et al [67] Mehmi et al [64] Ramasawmy et al [66]	Some concerns about reflexivity [48,56,57,64,65,67], analytical rigor [48,56,63,66], and recruitment [57]	No concerns—strongly evidenced with qualitative or quantitative data	No concerns [50-52,54,55, 57-67] Minor concerns [48,56]	No concerns [55,56,63,65-67] Minor concerns [48,61,62,64]	High confidence	Few concerns
Digitization and web-based consultations amplified existing inequalities in access to health care for many migrants because of a lack of digital literacy and access to technology compounded by language barriers and indirect discrimination.	Fu et al [5] Rodriguez et al [56] Stevens et al [51]	Some concerns about recruitment [5,57], analytical rigor [5,56], and reflexivity [56,57]	Minor concerns—strongly evidenced with qualitative data but varying experiences in some studies	No concerns [51] Minor concerns [5,56]	No concerns [5,56] Minor concerns [51]	High confidence	3 studies contributing data with good coherence and few other concerns
Although demand for video consultation services in primary care is likely to rise, for complex or sensitive problems, face-to-face consultations remain preferable.	Broffman et al [61]	Some concerns about analytical rigor	Minor concerns given methodological limitations	Minor concerns	No concerns	Moderate confidence	Only one study contributing data with minor concerns about analytical rigor