Considerations of diversity, equity, and inclusion in mental health apps: A scoping review of evaluation frameworks

Ramos, Giovanni; Ponting, Carolyn; Labao, Jerome P; Sobowale, Kunmi

doi:10.1016/j.brat.2021.103990

Cited by 87 publications

(63 citation statements)

References 96 publications

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“…The mixed evidence found across studies suggests there may also be intervention-specific characteristics that cause heterogeneity in effectiveness, which are useful to explore in future experimental studies. The results of the present review are in line with the findings of a recent review on mental health apps which also indicated that evaluation frameworks for mental health apps rarely include indicators for diversity and inclusion, such as cost or using simple language 83 . Including inequality indicators such as the PROGRESS plus criteria 84 in evaluation frameworks would be an important step towards making mHealth interventions accessible to marginalised groups which may be in greater need of support [27][28][29][30] .…”

Section: Implications and Future Researchsupporting

confidence: 88%

Is the uptake, engagement and effectiveness of exclusively mobile interventions for the promotion of weight-related behaviours equal for all? A systematic review

Szinay¹,

Forbes²,

Busse³

et al. 2022

Preprint

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Mobile health interventions are promising behaviour change tools. However, there is a concern that they may widen inequalities in health. This systematic review investigated differences in uptake of, engagement with, and effectiveness of mobile interventions for diet, physical activity, and sedentary behaviour based on a range of inequality indicators. The protocol was registered on PROSPERO (CRD42020192473). Six databases (CINAHL, EMBASE, ProQuest, PsycINFO, Pubmed, Web of Science) were searched. Publications were eligible for inclusion if they reported on an exclusively mobile intervention and examined outcomes by at least one inequality indicator. Sixteen publications reporting on 13 studies were included with most reporting on multiple behaviours and inequality indicators. Uptake was investigated in one study with no differences reported by the inequality indicators studied. Studies investigating engagement (n=7) reported differences by age (n=1), gender (n=3), ethnicity (n=2), and education (n=2), while those investigating effectiveness (n=9) reported differences by age (n=3), gender (n=5), education (n=2), occupation (n=1), and geographical location (n=1). Given the limited number of studies and their inconsistent findings, evidence of the presence of a digital divide in mobile interventions targeting weight-related behaviours is inconclusive. Therefore, we recommend that inequality indicators are specifically addressed, analysed and reported when evaluating mobile interventions.

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Section: Implications and Future Researchsupporting

confidence: 88%

Is the uptake, engagement and effectiveness of exclusively mobile interventions for the promotion of weight-related behaviours equal for all? A systematic review

Szinay¹,

Forbes²,

Busse³

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Lastly, youth experiencing pandemic related stressors such as parental job loss, eviction, or bereavement, often have elevated need for mental health services but may have difficulty accessing care, due to familial economic and housing stability ( Cénat et al, 2020 ). Given many clinics’ present adoption of hybrid models of care (i.e., in person and remote), we urgently need research that considers issues of equity and inclusion in the implementation of telehealth services to effectively address barriers to care for marginalized groups (Lattie et al, 2022; Ramos, Ponting, Labao, & Sobowale, 2021 ) and ensure safety.…”

Section: Has Covid-19 Impacted Mental Health Services and Service Use?mentioning

confidence: 99%

The impact of COVID-19 on child and adolescent mental health and treatment considerations

Chavira

Ponting

Ramos

2022

Behaviour Research and Therapy

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“…The intervention content is based on compassionate mind training, with a few additional elements of positive psychology (eg, functionality light of the day ) and mindful self-compassion (eg, exercise “How would you treat a friend?”). Diversity, equity, and inclusion design aspects (see the study by Ramos et al [ 48 ]) were addressed to some extent, for example, by offering content that is understandable to people with various degrees of exposure to formal education, alternatives to breath-focused exercises, closed captions for videos, and diversity in visual representation. Textbox 3 provides a brief overview of the intervention content, and Multimedia Appendix 2 and Multimedia Appendix 3 [ 40 ] provide an extensive overview, including aims and user outcomes, and persuasive design elements, respectively.…”

Section: Resultsmentioning

confidence: 99%

Integrating Top-down and Bottom-up Requirements in eHealth Development: The Case of a Mobile Self-compassion Intervention for People With Newly Diagnosed Cancer

Austin¹,

Drossaert²,

Dijk³

et al. 2022

JMIR Cancer

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Background Psychosocial eHealth interventions for people with cancer are promising in reducing distress; however, their results in terms of effects and adherence rates are quite mixed. Developing interventions with a solid evidence base while still ensuring adaptation to user wishes and needs is recommended to overcome this. As most models of eHealth development are based primarily on examining user experiences (so-called bottom-up requirements), it is not clear how theory and evidence (so-called top-down requirements) may best be integrated into the development process. Objective This study aims to investigate the integration of top-down and bottom-up requirements in the co-design of eHealth applications by building on the development of a mobile self-compassion intervention for people with newly diagnosed cancer. Methods Four co-design tasks were formulated at the start of the project and adjusted and evaluated throughout: explore bottom-up experiences, reassess top-down content, incorporate bottom-up and top-down input into concrete features and design, and synergize bottom-up and top-down input into the intervention context. These tasks were executed iteratively during a series of co-design sessions over the course of 2 years, in which 15 people with cancer and 7 nurses (recruited from 2 hospitals) participated. On the basis of the sessions, a list of requirements, a final intervention design, and an evaluation of the co-design process and tasks were yielded. Results The final list of requirements included intervention content (eg, major topics of compassionate mind training such as psychoeducation about 3 emotion systems and main issues that people with cancer encounter after diagnosis such as regulating information consumption), navigation, visual design, implementation strategies, and persuasive elements. The final intervention, Compas-Y, is a mobile self-compassion training comprising 6 training modules and several supportive functionalities such as a mood tracker and persuasive elements such as push notifications. The 4 co-design tasks helped overcome challenges in the development process such as dealing with conflicting top-down and bottom-up requirements and enabled the integration of all main requirements into the design. Conclusions This study addressed the necessary integration of top-down and bottom-up requirements into eHealth development by examining a preliminary model of 4 co-design tasks. Broader considerations regarding the design of a mobile intervention based on traditional intervention formats and merging the scientific disciplines of psychology and design research are discussed.

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Considerations of diversity, equity, and inclusion in mental health apps: A scoping review of evaluation frameworks

Cited by 87 publications

References 96 publications

Is the uptake, engagement and effectiveness of exclusively mobile interventions for the promotion of weight-related behaviours equal for all? A systematic review

Is the uptake, engagement and effectiveness of exclusively mobile interventions for the promotion of weight-related behaviours equal for all? A systematic review

The impact of COVID-19 on child and adolescent mental health and treatment considerations

Integrating Top-down and Bottom-up Requirements in eHealth Development: The Case of a Mobile Self-compassion Intervention for People With Newly Diagnosed Cancer

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