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数字健康干预面向所有人?审视数字健康干预研究过程各个阶段的包容性。

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

机构信息

Department of Public Health Sciences, School of Medicine, University of Virginia, PO Box 800765, Charlottesville, VA, 22908-0765, USA.

Department of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610-0165, USA.

出版信息

Trials. 2024 Jan 30;25(1):98. doi: 10.1186/s13063-024-07937-w.

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.

摘要

数字干预为改善健康提供了许多可能性,因为远程干预可以提高服务不足的社会群体的可及性和可获得性。然而,评估数字健康干预的研究表明,这些技术并非平等地使所有人受益,实际上有些技术似乎加剧了“数字健康鸿沟”。通过更好地了解这些潜在的陷阱,我们可以为缩小健康促进中的数字鸿沟做出贡献。本文的目的是强调和反思研究设计决策,这些决策可能会在关键研究阶段(招募、入组、参与、疗效/效果和保留)无意中加剧不平等。为了解决所强调的问题,我们提出了以下策略:(1)应修订“有效性”的标准定义,以纳入包容性衡量标准;(2)研究应报告广泛的潜在参与者招募、随机分组和保留的不平等指标,并进行敏感性分析,以检查数字干预效果和参与度方面的潜在社会人口差异;(3)应让历史上处于边缘地位的群体参与研究程序的设计,包括与招募、同意、干预实施和参与、评估和保留相关的程序;(4)应尽量减少并仔细选择入选标准,并简化筛选过程;(5)试验的预注册应包括样本多样性的招募基准和评估的社会人口特征的综合清单;(6)应在试验内嵌入研究,以系统地测试招募和保留策略,以提高包容性。这些策略的实施将提高数字健康试验招募、随机分组、参与和保留更广泛和更具代表性人群的能力,最终最大限度地缩小数字鸿沟,广泛改善人口健康。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21fc/10826214/168246626450/13063_2024_7937_Fig1_HTML.jpg

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