Technology-based interventions in substance use treatment to promote health equity among African Americans/Blacks, Hispanics/Latinx, and American Indians/Alaskan Natives: a scoping review of peer reviewed literature
Emily Hichborn, Sarah K. Moore, Phoebe Gauthier, Kathleen Bell, Chantal Lambert-Harris, Elizabeth C. Saunders,
Nico Agosti, Avery Turner, Jesse Boggis, Bethany McLeman, Lisa A. Marsch
Introduction: Technology-based interventions (TBIs) (i.e., web-based interventions and computer assisted therapies) have the potential to promote health equity in substance use and substance use disorder treatment (SUTx) for underrepresented groups (i.e., African Americans/Blacks, Hispanics/Latinx, and American Indians/Alaskan Natives) by removing barriers and increasing access to culturally relevant, effective treatments. However, technologies (emergent and more long-standing) may have unintended consequences that could perpetuate healthcare disparities among underrepresented groups. Health care research, and SUTx research specifically, is rarely conducted with these groups as a main focus. Therefore, an improved understanding of the literature at the intersection of SUTx, TBIs, and underrepresented groups is warranted to avoid exacerbating inequities and to promote health equity.
Objective: To explore peer-reviewed literature (January 2000-March 2021) that includes underrepresented groups in SUTx research using TBIs. We further seek to explore whether this subset of the research is race/ethnicity conscious (i.e., does the research consider underrepresented groups (beyond inclusion) in introduction, methods, results, and/or discussion).
Methods: Five electronic databases (MEDLINE, Scopus, Cochrane Library, CINAHL, and PsychInfo) were searched to identify SUTx research using TBIs and studies were screened for eligibility at the title/abstract and full-text levels. Studies were included if the participant sample is 50% or more underrepresented groups (i.e., African Americans/Blacks, Hispanics/Latinx, and American Indians/Alaskan Natives).
Results: One hundred twenty-two of 6,897 identified studies met inclusion criteria with 60 studies (49.2%) being race/ethnicity conscious. One hundred nine studies (89.3%) comprised African American/Black participants. Additionally, 24 studies (19.7%) included American Indian/Alaska Natives in the sample, and 81 (66.4%) studies included Hispanic/Latinx participants. The majority of studies focused on general substance use (n=58) and alcohol (n=32) as the target substances, and web-based interventions (n=59) and text messaging/telephone (n=35) as the primary TBIs.
Conclusions: The scoping review findings will provide a status update on emerging technologies and their potential to perpetuate health care disparities among historically underrepresented groups. These findings may also offer insights into how those who design TBIs may avoid worsening inequities through increasing the race/ethnicity consciousness of both research practices and technological innovations.