Evidence mapPaperPMID 38291539Full record

ArticleTrials2024

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

Rebecca A Krukowski, Kathryn M Ross, Max J Western, Rosie Cooper, Heide Busse, Cynthia Forbes, Emmanuel Kuntsche, Anila Allmeta, Anabelle Macedo Silva, Yetunde O John-Akinola and 1 more

Abstract readLetter
In one paragraph

Article in Trials, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
46citing papers in PubMed, 6 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

46 citing papers in PubMed, 6 syntheses or guidelines pooled it.

  1. Inequalities in Exclusively Mobile Interventions Targeting Weight-Related Behaviors: Systematic Review of Observational Studies.Obesity reviews : an official journal of the International Association for the Study of Obesity · 2026
    Pooled it
  2. Identifying Social Media-Based Interactions That Help Adults to Adhere to Weight Loss Goals: A Systematic Review.Obesity reviews : an official journal of the International Association for the Study of Obesity · 2026
    Pooled it
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  6. Digital versus nondigital behavioral interventions on cardiovascular risk reduction: systematic review and meta-analysis.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2025
    Pooled it
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  8. An exploratory study to understand how rurality status and demographic characteristics are associated with enrollment, engagement, and retention in a digital health intervention targeting the Appalachian region.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025
    Trial
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Rebecca A KrukowskiDepartment of Public Health Sciences, School of Medicine, University of Virginia, PO Box 800765, Charlottesville, VA, 22908-0765, USA. wae4mq@virginia.edu.ORCID http://orcid.org/0000-0001-9193-2783
Kathryn M RossDepartment of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610-0165, USA.
Max J WesternDepartment for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
Rosie CooperNuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, UK.
Heide BusseLeibniz Institute for Prevention Research and Epidemiology- BIPS, Achterstraße 30, 28359, Bremen, Germany.
Cynthia ForbesHull York Medical School, University of Hull, Allam Medical Building, Cottingham Road, Hull, UK.
Emmanuel KuntscheCentre for Alcohol Policy Research, La Trobe University, Plenty Road and Kingsbury Drive, Melbourne, 3086 VIC, Australia.
Anila AllmetaUniversity of Bayreuth, Fritz-Hornschuch-Straße 13, 95326, Kulmbach, Germany.
Anabelle Macedo SilvaInstituto de Estudos Em Saúde Coletiva IESC/ Universidade Federal Do Rio de Janeiro /Leibiniz Science Campus Digital Public Health/Ministério Público Do Estado Do Rio de Janeiro, Rua das Bauhineas 200, Bl B 1602, Península, Barra da Tijuca, Rio de Janeiro, 22776-090, Brazil.
Yetunde O John-AkinolaDepartment of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, College of Medicine, Queen Elizabeth Road, UCH Campus, Ibadan, Nigeria.
Laura M KönigUniversity of Bayreuth, Faculty of Life Sciences: Food, Nutrition and Health University of Vienna, Faculty of Psychology, Wächtergasse 1, 1010, Vienna, Austria.

Funding

VIVARIUM FACILITY--COREP30CA044579 · NCI · UNIVERSITY OF VIRGINIA CHARLOTTESVILLE · 1987 to 2025
$29.7M
NCI NIH HHS P30 CA044579Universität Bayreuth Centre of International Excellence "Alexander von Humboldt"
6 · The paper itself

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.

Indexed as

Digital HealthHealth PromotionHumansResearch Design

Identifiers

PMID38291539
PMCPMC10826214

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.