Audit data governance for disability-inclusive public services: A systematic review and integrative S-A-C framework
Clinical Snapshot
PICO Framework
| P — Population | Public services and systems serving people with disabilities |
| I — Intervention | Audit data governance frameworks and practices |
| C — Comparator | Various governance approaches or absence of structured audit data governance |
| O — Outcomes | Service equity, accountability, transparency, contestability, and distributive impacts for disability-inclusive service delivery |
Bottom Line
This systematic review synthesises evidence from 125 studies to propose a novel S-A-C framework explaining how audit data governance, service delivery arrangements, and organisational culture interact to shape accountability and equity in disability-inclusive digital public services. The framework identifies five key tensions that organisations must navigate: balancing optimisation with inclusion, transparency with privacy, standardisation with reasonable accommodation, automated decision-making with meaningful contestability, and compliance-focused auditing with learning-oriented governance. While the review provides valuable conceptual insights for healthcare organisations serving people with disabilities, the high heterogeneity of included studies and lack of quantitative synthesis limits the strength of evidence for specific interventions. The framework offers practical leverage points for governance reform but requires empirical testing and adaptation to specific healthcare contexts. Australian healthcare organisations implementing digital health initiatives or NDIS services may find this framework useful for developing oversight-ready, inclusive service delivery models, though local validation studies would strengthen the evidence base.
Key Findings
P Value: Not applicable - no statistical analysis
Effect Size: Not applicable - qualitative synthesis
Primary Outcome: Three-dimensional S-A-C framework explaining co-production of auditability and disability inclusion
Nnt Or Sensitivity: Framework identifies five recurring tensions: optimization vs inclusion; transparency vs privacy; standardisation vs accommodation; automated vs contestable decisions; compliance vs learning orientation
Confidence Interval: Not applicable - narrative review
Clinical Application
Framework provides practical leverage points for governance reform but requires organisational commitment and technical infrastructure investment Highly relevant to Australian Disability Discrimination Act compliance, NDIS service delivery, and digital health initiatives under Australia's Digital Health Strategy. Framework could inform TGA medical device software governance and support RACGP digital health guidelines implementation Healthcare organisations providing digital services to people with disabilities, particularly relevant for public health systems and disability support services
Abstract
This study consolidates interdisciplinary evidence on how audit data governance shapes accountability and service equity in data-intensive public services, with specific sensitivity to disability-inclusive delivery. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, we conducted a protocol-driven systematic literature review of peer-reviewed studies and selected institutional and standards sources published between 2010 and 2025. We searched Scopus and complemented database retrieval with targeted searches of audit, digital government, accessibility, and data-governance portals. We applied a theory-led narrative synthesis to accommodate heterogeneity in designs, domains, and outcome reporting. Synthesizing 125 records, we find that governance effects are produced through three interacting dimensions-service delivery for people with disabilities (S), audit data governance (A), and data-driven culture (C)-that jointly condition transparency, contestability, and distributive impacts. Service delivery arrangements shape where data are generated, which encounters are recorded, and whether access needs, reasonable accommodations, and complaints become organizationally legible. Audit data governance conditions the credibility and usability of audit trails through provenance, metadata, retention, audit logging, and role-appropriate oversight access, shaping both oversight feasibility and privacy risk. Data-driven culture conditions how evidence is interpreted and acted upon, including data literacy, the standing of experiential evidence, and whether audit signals support learning or only compliance. Across the corpus, recurring tensions emerge between optimization and inclusion; transparency and privacy; standardization and reasonable accommodation; automated decisioning and meaningful contestability; and compliance-oriented auditing and learning-oriented governance. Drawing these mechanisms together, we propose an integrative framework linking S, A, and C to explain how auditability and disability inclusion are co-produced across the digital service lifecycle. The framework identifies leverage points for governance reform and evaluation and outlines implications for future empirical testing and for practitioners seeking trustworthy, oversight-ready, inclusive digital public services. A review protocol was prepared before the review; the review was not registered.
References
- 1.Chaiyasuk, S., Rugchatjaroen, K., Sirisunhirun, S., Dhirathiti, N. S., Amornsiriphong, S., & Ploywan, P. (2026). Audit data governance for disability-inclusive public services: A systematic review and integrative S-A-C framework. *PLoS One*. https://doi.org/10.1371/journal.pone.0350135
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