How Do Digital Affordances Interact to Advance Social Sustainability? Evidence from Saudi Arabia's mHealth Platform (the Sehhaty app).

Problem: Achieving the Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), requires healthcare systems that are not only clinically effective but also socially sustainable - ensuring equitable access, workforce well-being, cultural competence, and community engagement. The WHO emphasizes integrated people-cantered health services and digital health as key strategies for universal health coverage and achieving health-related SDGs. However, a critical gap exists in understanding how digital health innovations contribute to social sustainability dimensions within healthcare systems, particularly in rapidly modernizing contexts. Saudi Arabia faces acute challenges: vast geography, diverse population distribution, resource concentration in urban centres, and high prevalence of non-communicable diseases.

 

 The Kingdom's Vision 2030 positions digital health transformation, exemplified by the Ministry of Health's nationwide Sehhaty application, as central to building accessible, patient-cantered, and sustainable healthcare. Yet empirical evidence on how such mHealth platforms advance social sustainability within healthcare remains limited.

 

Aim: This research examines how the implementation of the Sehhaty mHealth application contributes to advancing social sustainability within Saudi Arabia's healthcare system, addressing the knowledge gap between WHO's digital health strategy and on-ground implementation realities.

 

Methods: Qualitative research design employing semi-structured interviews with 38 diverse stakeholders (physicians, healthcare professionals, patients, technology developers, and senior managers) across urban and rural healthcare settings in Tabuk province. Thematic analysis, guided by affordance theory, distinguished between affordance perception and actualization to understand mechanisms through which digital health technologies enable achievement of social sustainability objectives aligned with SDG targets.

 

Findings: The analysis identified 16 distinct digital affordances organized across four major themes: (1) Expanding Healthcare Accessibility and Inclusivity, (2) Supporting System Efficiency, (3) Empowering Healthcare Workforce, and (4) Fostering Patient Empowerment and Preventive Care. Four affordance interaction mechanisms (Reciprocal Reinforcement, Feedback Loops, Multiplicative Effects, and Foundational Relationships) revealed how digital affordances interact to produce amplified social sustainability outcomes. Significant constraints limiting full actualization of these affordances included infrastructure limitations, digital literacy challenges, and cultural resistance.

 

Implications: This research demonstrates how mHealth platforms can serve as structural enablers of socially sustainable healthcare system. The findings provide actionable insights for healthcare organizations implementing digital health initiatives, particularly in contexts undergoing rapid modernization. The affordance interaction framework advances theoretical understanding of how digital technologies facilitate healthcare delivery while addressing equity, workforce well-being, cultural competence, community engagement, and ethical care dimensions essential to social sustainability.

 

Keywords: mHealth, digital health, social sustainability, integrated care, SDGs, WHO strategy, universal health coverage, affordance theory, Saudi Arabia, Sehhaty app