Public value and digital health: The example of guiding values in the national digital health strategy of France

Introduction: In the WHO European Region, 44 of 53 reporting Member States (MS) have a national digital health strategy (NDHS) or policy. Their formulation is heterogenous and evolving and should best reflect public common interest. This research aims to explore how a public value approach improves the relevance of digital health policies and services, increasing their capacity to better serve the diverse range of societal interests. It utilises the guiding values within the French NDHS as an example before discussing other digital health policies such as the European Heath Data Space. Methods: Three homogenous focus group discussions were conducted in November and December 2023. Each focus group separately gathered distinct stakeholders: public clients, health professionals, private sector. 19 participants were included in the study. Data collection comprised live polling and semi-structured discussion. Results were analysed considering the pre-defined stakeholder groups and the values discussed during the study. Results: Findings reveal both technical and cultural challenges in digital health that highlight the need for adaptable frameworks across different contexts. Stakeholder insights informed a framework classifying public values into democratic and managerial categories, suggesting themes that may be relevant to digital health strategies in other national and regional settings. Discussion: Public value is discussed as a multidimensional concept, and the plurality of its perceptions give basis for tailored approaches to serve different value-beneficiaries comprehensively. We propose this values-based approach as a systematic model for supra-, sub-, and national scales and additional policy topics, beyond digital health strategies. Conclusion: The study suggests that using a public value lens considering multiple perceptions is valuable for advancing digital health policy in a responsible and ethical manner. Such an approach could promote wider governance of and adoption of digital health. To evolve the framework, application in multiple and large ecosystems at different levels should be considered.