Research on Digital Health Stroke Interventions Not Diverse Enough
An analysis shows digital health interventions can improve stroke prevention, but due to a lack of diversity, their efficacy among minority groups is uncertain.
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By Anuja Vaidya
- It is unclear if digital health interventions for stroke prevention and care are effective among historically underrepresented groups like the Black and Latinx populations, according to new research.
Published in BMC Public Health, the study examines the efficacy of digital health interventions for stroke prevention and care and assesses the inclusion of Black and Latinx populations in the evidence base supporting these interventions.
Stroke is a leading cause of death in the United States, with more than 795,000 people having a stroke every year, according to the Centers for Disease Control and Prevention (CDC). The risk of having a stroke is much higher among minority groups. For instance, non-Hispanic Black adults’ stroke risk is twice as high as White adults. Further, Latinx men are projected to have the highest increase in stroke death rates by 2030, American Heart Association data shows.
While digital health interventions have grown significantly in the last few years, the digital divide and underrepresentation in research may prevent minority groups from benefiting.
For the study, researchers from Downstate Health Sciences University’s School of Public Health, College of Medicine, School of Health Professions, and Department of Neurology/Stroke Center examined studies from PubMed, the Web of Science, and EMBASE databases. They searched for peer-reviewed systematic reviews or meta-analyses of experimental studies focusing on the impact of digital health interventions on stroke risk factors and outcomes in adults.
The researchers found 38 systematic reviews published between 2015 and 2021 that met the inclusion criteria. These reviews included 519 individual studies. The research team identified six functional categories and eight digital health modalities. The eight modalities were computer-delivered, web-based, messaging, telestroke, mobile applications, health devices, virtual reality, and phone-based.
The analysis shows that case management (63 percent) and health monitoring (50 percent) were the most common intervention functionalities, and mobile applications and web-based interventions were the two most commonly studied modalities.
Researchers found strong evidence that simple messaging interventions could significantly decrease hemoglobin A1c (HbA1c), fasting blood sugar, and blood pressure and increase physical activity and medication adherence.
Phone-based interventions also significantly increased medication adherence and decreased blood pressure.
Additionally, there was strong evidence that web-based interventions can reduce HbA1c, fasting blood sugar, and various anthropometry measures, including body weight and waist circumference, but researchers stated that their ability to decrease blood pressure and cholesterol levels may vary.
Further, telestroke significantly impacted onset-to-door/onset-to-treatment measures and decreased the length of hospital stay. However, one review found no evidence that telestroke could improve post-stroke function. Virtual reality was also used to evaluate balance, mobility, and function post-stroke.
Though the reviews highlight the efficacy of digital health interventions, particularly those targeting blood pressure management and medication adherence, the research is not diverse, researchers noted.
The studies represent 43 unique countries, with 38 percent being conducted in the US and 29.5 percent in Europe. Only 1 percent of the studies were conducted in South America and Africa.
A little over half (54.8 percent) of the US studies adequately reported racial or ethnic group distribution. The remaining studies did not report race/ethnicity or did so inadequately. When race was reported, 63.4 percent of the sample was White, 27 percent was Black, 17.1 percent was Latinx, and 17.4 percent was Asian, on average.
“Digital interventions expand access to care while still providing a means to receive consultation, education, case management, disease monitoring, mentoring, and rehabilitation,” the researchers concluded. “However, interventions cannot be successful without users — whose characteristics and deployment environment must be carefully considered when designing interventions.”
