Digital health interventions for all? Examining inclusivity across all stages of the digital health intervention research process

Abstract

Digital interventions offer many possibilities for improving health, as remote interventions can enhance reach and access to underserved groups of society. However, research evaluating digital health interventions demonstrates that such technologies do not equally benefit all and that some in fact seem to reinforce a “digital health divide.” By better understanding these potential pitfalls, we may contribute to narrowing the digital divide in health promotion. The aim of this article is to highlight and reflect upon study design decisions that might unintentionally enhance inequities across key research stages—recruitment, enrollment, engagement, efficacy/effectiveness, and retention. To address the concerns highlighted, we propose strategies including (1) the standard definition of “effectiveness” should be revised to include a measure of inclusivity; (2) studies should report a broad range of potential inequity indicators of participants recruited, randomized, and retained and should conduct sensitivity analyses examining potential sociodemographic differences for both the effect and engagement of the digital interventions; (3) participants from historically marginalized groups should be involved in the design of study procedures, including those related to recruitment, consent, intervention implementation and engagement, assessment, and retention; (4) eligibility criteria should be minimized and carefully selected and the screening process should be streamlined; (5) preregistration of trials should include recruitment benchmarks for sample diversity and comprehensive lists of sociodemographic characteristics assessed; and (6) studies within trials should be embedded to systematically test recruitment and retention strategies to improve inclusivity. The implementation of these strategies would enhance the ability of digital health trials to recruit, randomize, engage, and retain a broader and more representative population in trials, ultimately minimizing the digital divide and broadly improving population health.

Research Trends in the Study of Acceptability of Digital Mental Health-Related Interventions: A Bibliometric and Network Visualisation Analysis

“…For example, systematic reviews in high-, middle-, and low-income countries can explore the relevant evidence on interventions' acceptability within those contexts and the barriers for their implementation. Moreover, future research will need to explore situations and contexts where digital mental health-related interventions may even extend existing inequalities (Krukowski et al 2024). Finally, both reviews of existing evidence and empirical research can inform the development of guidelines for intervention acceptability to be adequately reported even in cases where it serves as a secondary outcome to large randomised controlled trials.…”