Use of Digital Mental Health for Marginalized and Underserved Populations

Abstract

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Research with Marginalized Communities: Challenges to Continuity During the COVID-19 Pandemic

“…Due to longstanding political, economic, educational, and employment marginalization, many in our communities do not have access to the technology and/or technological skills needed to be able to participate in online research [5]. It has previously been documented that online research and eHealth approaches are less likely to reach more marginalized populations, such as people of color, homeless people, and LGBTQ youth [6,7].…”

“…Even among those who may have access to the internet and a smartphone or computer, due to educational marginalization, many in our communities do not have the technological skills needed to navigate online studies, sign electronic documents, or read and respond to self-administered surveys [7]. As we attempt to reconvene our peer-delivered intervention groups and individual sessions, we are finding that our participants have very little, if any, familiarity with applications such as Zoom, and require extensive technical assistance to install, set up, register for, and use these programs.…”

“…Interruptions to the delivery of interventions in the context of a clinical trial can be especially difficult. While adapting the intervention to an online version is critical to maintaining continuity of the research, doing so without time to undertake proper adaptation and training procedures can create unexpected risks and burdens [7]. Using a secure online platform like Zoom often requires technical assistance, as previously stated, and questions about privacy often arise when participants live in shared spaces [19].…”

eHealth and mHealth Interventions for Ethnic Minority and Historically Underserved Populations in Developed Countries: an Umbrella Review

“…Despite the growing popularity of eHealth and mHealth interventions, there is limited evidence about their scalability and long-term impact on health outcomes due to the low quality of the evidence, particularly from umbrella reviews and overviews of previous SRs (Marcolino et al 2018). Schueller et al (2019) state "much work still needs to be done" (p. 252) to develop digital mental health interventions for marginalized and underserved populations, in part because of SR findings that a number of pilot studies have not "follow[ed]-up with an implementation component" (p. 251). It is important to conduct high quality SRs on minority populations as they face discrepancies in accessing mental health services and, hence, poor treatment outcomes is not uncommon .…”

“…Finally, considering that the current review assessed only six intervention SRs published in English, and it may be concluded that there might be more SRs to assess in relation to the topic examined here published in other languages as well as those published after the time of this umbrella review. For example, a SR that was published a few months after the completion of the present umbrella review, and reviewed the evidence on digital mental health interventions for marginalised and underserved populations (Latin and African Americans, rural populations, individuals experiencing homelessness, and sexual and gender minorities) concluded that there is emerging evidence for the feasibility and acceptability of those interventions but there is a lack of evidence on their efficacy on a large-scale (Schueller et al 2019). Those findings offer a clear description of the state of the evidence in the field applying specific quality criteria that can inform the focus of future SRs and assist policymakers to develop evidence-based policies.…”