Professorship of Public Health and Prevention, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
Int J Equity Health. 2024 Sep 11;23(1):181. doi: 10.1186/s12939-024-02267-4.
The growing use of mobile health applications (apps) for managing diabetes and hypertension entails an increased need to understand their effectiveness among different population groups. It is unclear if efficacy and effectiveness trials currently provide evidence of differential effectiveness, and if they do, a summary of such evidence is missing. Our study identified to what extent sociocultural and socioeconomic inequalities were considered in effectiveness trials of mobile health apps in diabetic and hypertensive patients and if these inequalities moderated app effectiveness.
We built on our recent umbrella review that synthesized systematic reviews (SRs) of randomized controlled trials (RCTs) on the effectiveness of health apps. Using standard SR methodologies, we identified and assessed all primary RCTs from these SRs that focused on diabetes and/or hypertension and reported on health-related outcomes and inequality-related characteristics across intervention arms. We used the PROGRESS-Plus framework to define inequality-related characteristics that affect health opportunities and outcomes. We used harvest plots to summarize the subgroups (stratified analyses or interaction terms) on moderating effects of PROGRESS-Plus. We assessed study quality using the Risk of Bias 2 tool.
We included 72 published articles of 65 unique RCTs. Gender, age, and education were the most frequently described PROGRESS-Plus characteristics at baseline in more than half of the studies. Ethnicity and occupation followed in 21 and 15 RCTs, respectively. Seven trials investigated the moderating effect of age, gender or ethnicity on app effectiveness through subgroup analyses. Results were equivocal and covered a heterogenous set of outcomes. Results showed some concerns for a high risk of bias, mostly because participants could not be blinded to their intervention allocation.
Besides frequently available gender, age, and education descriptives, other relevant sociocultural or socioeconomic characteristics were neither sufficiently reported nor analyzed. We encourage researchers to investigate how these characteristics moderate the effectiveness of health apps to better understand how effect heterogeneity for apps across different sociocultural or socioeconomic groups affects inequalities, to support more equitable management of non-communicable diseases in increasingly digitalized systems.
移动医疗应用程序（apps）在管理糖尿病和高血压方面的应用越来越多，因此需要更多地了解其在不同人群中的有效性。目前尚不清楚疗效和有效性试验是否提供了差异有效性的证据，如果有，也缺少此类证据的总结。我们的研究旨在确定在糖尿病和高血压患者使用移动医疗应用程序的疗效试验中，社会文化和社会经济不平等因素的考虑程度，以及这些不平等因素是否调节了应用程序的效果。
我们在最近的系统综述基础上进行了扩展，该综述综合了关于健康应用程序有效性的系统评价（SRs）。我们采用标准的 SR 方法，从这些 SR 中确定并评估了所有关注糖尿病和/或高血压并报告干预组之间与健康相关的结果和不平等相关特征的原发性 RCT。我们使用 PROGRESS-Plus 框架来定义影响健康机会和结果的不平等相关特征。我们使用收获图来总结 PROGRESS-Plus 调节作用的亚组（分层分析或交互项）。我们使用风险偏倚 2 工具评估研究质量。
我们纳入了 72 篇已发表的文章，涉及 65 项独特的 RCT。在超过一半的研究中，性别、年龄和教育程度是最常描述的基线 PROGRESS-Plus 特征。种族和职业分别在 21 项和 15 项 RCT 中得到描述。有 7 项试验通过亚组分析研究了年龄、性别或种族对应用程序效果的调节作用。结果存在分歧，涵盖了一组异质的结果。结果表明，由于参与者无法对其干预分配进行盲法，因此存在较高的偏倚风险。
除了经常提供的性别、年龄和教育描述外，其他相关的社会文化或社会经济特征既没有得到充分报告，也没有进行分析。我们鼓励研究人员调查这些特征如何调节健康应用程序的有效性，以更好地了解应用程序在不同社会文化或社会经济群体中的效果异质性如何影响不平等现象，从而支持在日益数字化的系统中更公平地管理非传染性疾病。
