Dawson Aprill Z, Walker Rebekah J, Campbell Jennifer A, Davidson Tatiana M, Egede Leonard E
Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
Mhealth. 2020 Jul 5;6:30. doi: 10.21037/mhealth.2019.12.03. eCollection 2020.
Approximately 370-500 million Indigenous people live worldwide. While Indigenous peoples make up only 5% of the world's population, they account for 15% of the extreme poor and have life expectancy that is 20 years shorter than that of non-Indigenous people. Access to healthcare has been identified as an important social determinant of health and key driver of health outcomes. Indigenous populations often face barriers to accessing healthcare including living in remote areas, lacking financial resources, and having cultural differences. Telehealth, the utililzation of any synchronous modality, including phone, video, or teleconferencing technology used to support the provision of long-distance health care and health education, is a feasible and cost-effective treatment delivery mechanism that has successfully addressed access barriers faced by vulnerable populations globally, however, few studies have included indigenous populations and the application of this technology to improve physical and mental health outcomes. This systematic review aims to identify trials that were conducted among Indigenous adults, and to summarize the components of interventions that have been found to effectively improve the health of Indigenous peoples. The PRISMA guidelines for reporting of systematic reviews were followed in preparing this manuscript. Studies were identified by searching PubMed, Scopus, and PsychInfo databases for clinical trial articles on Indigenous peoples and mental and physical health, published between January 1, 1998 and December 31, 2018. Eligibility criteria for determining studies to include in the analysis were as follows: (I) ≥18 years of age; (II) indigenous peoples; (III) any technology-based intervention; (IV) studies included at least one of the following mental health (depression, post-traumatic stress disorder, suicide) and physical health (mortality, blood pressure, hemoglobin A1C, cholesterol, quality of life) outcomes; (V) clinical trials. A total of 2,662 articles were identified and six were included in the final review based on pre-specified eligibility criteria. Three were conducted in the United States, one study was conducted in Canada, and two were conducted in New Zealand. Study sample sizes ranged from 20 to 762, intervention delivery times ranged from three to 20 months and utilized telephone, internet and SMS messaging as the type of technology. There is a paucity of evidence on the use of telehealth programs to increase access to chronic disease programs in Indigenous populations. This review highlights the importance of culturally tailoring programs despite the modality in which they are delivered, and recommends telephone-based delivery facilitated by a trained health professional. Telehealth has great promise for meeting the health needs of highly marginalized Indigenous populations around the world, however, at this point more research is needed to understand how best to structure and deliver these programs for maximum effect.
全球约有3.7亿至5亿原住民。虽然原住民仅占世界人口的5%，但他们却占极端贫困人口的15%，且预期寿命比非原住民短20年。获得医疗保健已被确定为健康的重要社会决定因素和健康结果的关键驱动因素。原住民在获得医疗保健方面往往面临障碍，包括居住在偏远地区、缺乏财政资源以及存在文化差异。远程医疗是指利用任何同步方式，包括电话、视频或电话会议技术来支持提供远程医疗保健和健康教育，它是一种可行且具有成本效益的治疗提供机制，已成功解决了全球弱势群体面临的获取障碍。然而，很少有研究将原住民纳入其中，也很少研究这种技术在改善身心健康结果方面的应用。本系统评价旨在确定在成年原住民中进行的试验，并总结已发现能有效改善原住民健康的干预措施的组成部分。撰写本手稿时遵循了系统评价报告的PRISMA指南。通过在PubMed、Scopus和PsychInfo数据库中搜索1998年1月1日至2018年12月31日期间发表的关于原住民与身心健康的临床试验文章来确定研究。确定纳入分析的研究的资格标准如下：（I）年龄≥18岁；（II）原住民；（III）任何基于技术的干预措施；（IV）研究至少包括以下身心健康结果中的一项（心理健康：抑郁症、创伤后应激障碍、自杀；身体健康：死亡率、血压、糖化血红蛋白A1C、胆固醇、生活质量）；（V）临床试验。共识别出2662篇文章，根据预先指定的资格标准最终纳入6篇进行综述。3项研究在美国进行，1项研究在加拿大进行，2项研究在新西兰进行。研究样本量从20到762不等，干预实施时间从3到20个月不等，使用电话、互联网和短信作为技术类型。关于利用远程医疗项目增加原住民获得慢性病项目机会的证据很少。本综述强调了根据文化定制项目的重要性，无论其采用何种方式，并建议由训练有素的卫生专业人员协助进行基于电话的服务。远程医疗在满足世界各地高度边缘化的原住民的健康需求方面具有巨大潜力，然而，目前还需要更多研究来了解如何以最佳方式构建和提供这些项目以实现最大效果。
