As digital health technologies redefi ne care delivery globally, Puerto Rico faces urgent and unique challenges. Although a U.S. territory, its healthcare infrastructure more closely resembles that of low- and middle-income countries, creating a stark disconnect between federal digital health policies and on-the-ground realities. The island stands at the intersection of two incompatible systems: one that presumes digital readiness, and another shaped by underinvestment, disaster vulnerability, and systemic neglect. This thesis examines how digital determinants of health, broadband access, power stability, and digital literacy, impact telehealth equity in Puerto Rico. Based on 16 in-depth interviews and 33 patient surveys, fi ndings reveal that systemic disparities disproportionately aff ect rural and elderly populations. However, community-led pilot programs demonstrate that localized, culturally responsive solutions can bridge the divide. To advance digital health equity, this research proposes a multi-level policy framework focused on infrastructure modernization, permanent reimbursement parity, and a Digital Health Navigator workforce, reframing digital health as a public health equity imperative.
Ermelinda Calderón (Sun,) studied this question.