Despite the potential of digital health interventions (DHIs), evaluations of their effectiveness face challenges. DHIs are complex interventions and currently established evaluation methods, e.g., the randomised controlled trial (RCT), are limited in their application. This study aimed at identifying alternatives to RCTs as potentially more appropriate evaluation approaches. A scoping review was conducted to provide an overview of existing evaluation methods of DHIs beyond the RCT. Cochrane Central Register of Controlled Trials, MEDLINE, Web of Science, and EMBASE were screened in May 2021 to identify relevant publications, while using defined inclusion and exclusion criteria. Eight studies were extracted for a synthesis comprising four alternative evaluation designs. Factorial designs were mostly used to evaluate DHIs followed by stepped-wedge designs, sequential multiple assignment randomised trials (SMARTs), and micro randomised trials (MRTs). Some of these methods allow for the adaptation of interventions (e.g., SMART or MRT) and the evaluation of specific components of interventions (e.g., factorial designs). Thus, they are appropriate for addressing some specific needs in the evaluation of DHIs. However, it remains unsolved how to establish these alternative evaluation designs in research practice and how to deal with the limitations of the designs.
Virtual reality (VR) is an innovative tool for alcohol prevention among adolescents. However, many aspects of virtual simulations for alcohol prevention remained unstudied, and research on opportunities for tailoring such tools to users’ gender using avatar-based pathways is lacking. The present study, therefore, explores adolescents’ perceptions of gender portrayal and gender tailoring using Virtual LimitLab—a VR simulation for building refusal skills for dealing with peer pressure to consume alcohol. Focus groups were conducted after individual simulation testing with 13 adolescents in four groups, whose statements and discussion underwent thematic analysis. Three main themes were identified: the relevance of gender, opinions on different tailoring options for gender, and opinions on flirt orientation. Divergent arguments for different tailoring options and representations of gender in the simulation were proposed. Some participants changed opinions during discussions. Sexual harassment was consensually deemed an important issue that is linked to both partying and alcohol and was concluded to require being addressed along with alcohol prevention. A consensus also formed around open flirting possibilities (regardless of gender), and awareness of non-binary peers was raised. Based on the observed sensitivity of the adolescents to gender diversity, it is necessary to include LGBTQIA+ adolescents when developing gender-sensitive simulations.
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