Equity and behavioral digital health interventions: Strategies to improve benefit and reach

Abstract

Background Behavioral digital health interventions (e.g., mobile apps, websites, wearables) have been applied widely to improve health outcomes. However, many groups (e.g., people with low income levels, people who are geographically isolated, older adults) may face obstacles to technology access and use. In addition, research has found that biases and stereotypes can be embedded within digital health interventions. As such, behavioral digital health interventions that intend to improve overall population health may unintentionally widen health-related inequities. Purpose This commentary offers guidance and strategies to mitigate these risks when using technology as a means for delivering a behavioral health intervention. Methods A collaborative working group from Society of Behavioral Medicine’s Health Equity Special Interest Group developed a framework to center equity in the development, testing and dissemination of behavioral digital health interventions. Results We introduce Partner, Identify, Demonstrate, Access, Report (PIDAR), a 5-point framework to avoid the creation, perpetuation, and/or widening of health inequities in behavioral digital health work. Conclusions It is critically important to prioritize equity when conducting digital health research. The PIDAR framework can serve as a guide for behavioral scientists, clinicians and developers.

Impact of an automated, remote monitoring and coaching intervention in reducing hospice cancer family caregiving burden: A multisite randomized controlled trial

“…This underscores the potential value of digital tools in addressing inequities, particularly tools that do not require the internet or a smartphone, such as our IVR-based system, and can be accessed by caregivers wherever they are providing care. 39,40 The use of digital technology to deliver the SCH intervention allowed us to address some of the shortcomings in caregiver interventions to-date. [41][42][43] SCH decreases the need for skilled pro- There is a growing recognition that optimal cancer care must -1179…”

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

“… Evaluation of potential subgroup differences in engagement is critical; researchers should conduct sensitivity analyses examining sociodemographic differences in digital intervention engagement during formative, intervention-development periods (i.e., not waiting just to examine differences in efficacy and effectiveness trials). Attempts to establish specific strategies for improving engagement should be made by engaging participants from historically under-represented groups in the design of the intervention [ 44 , 45 ], using established patient and public involvement techniques to establish challenges and potential solutions (see [ 46 ] for a case study). …”

“…Attempts to establish specific strategies for improving engagement should be made by engaging participants from historically under-represented groups in the design of the intervention [ 44 , 45 ], using established patient and public involvement techniques to establish challenges and potential solutions (see [ 46 ] for a case study).…”

“… When reporting sociodemographic characteristics of study samples for digital intervention trials (again not only reporting on participants screened and recruited/randomized but also sociodemographic characteristics related to retention), researchers should consider a wide range of potential inequality indicators beyond the commonly reported age and gender variables. Cochrane’s PROGRESS plus framework provides an overview of socio-demographic factors that have been associated with health disparities [ 45 ]. Indeed, several factors listed in this framework have been associated with the digital divide, as evidenced in the meta-analysis of Western et al which showed that low SES populations (based on education attainment, income, and deprivation) did not benefit from digital physical activity interventions that high SES populations did [ 10 ].…”

A mobile app providing individually-tailored psychoeducation about sleep for older adults with chronic health conditions and low health literacy

“…Similarly, Gibbons (2011) proposes that Web 2.0 technologies such as social media could be harnessed to provide health promotion and education to minoritized and medically underserved groups. Several authors have emphasized the need to address sleep disparities and proposed actionable strategies (Billings et al, 2021; Hughes et al, 2022; Jackson et al, 2020; Miller et al, 2023). By applying health equity frameworks, engaging communities, and targeting social determinants of health, digital therapeutics can fulfil their potential to reduce disparities and empower marginalized groups.…”