The use of digital health interventions for cardiometabolic diseases among South Asian and Black minority ethnic groups: A realist review (Preprint)

Abstract

BACKGROUND Digital health interventions (DHIs), have become increasingly common for the prevention and management of cardiometabolic disease. However, there is limited evidence for the suitability of these approaches in minority ethnic populations, who are at increased risk of these diseases. OBJECTIVE This study aims to investigate the use of digital health interventions (DHIs) for cardiovascular disease (CVD) and/or type 2 diabetes (T2DM) among minority ethnic populations in majority White, English-speaking countries; focussing on people who identify as South Asian, Black, and/or African-American. METHODS A realist methodology framework was followed, in which a literature search was conducted to develop context-mechanism-outcome configurations (CMOcs), including the contexts DHIs work in for the target minority ethnic groups, the mechanisms that these contexts trigger, and resulting health outcomes. After systematic searches, qualitative analysis of included studies was conducted using deductive and inductive coding. RESULTS 15 studies of uptake of DHIs for CVD and/or diabetes were identified, of which 13 focused on people from an African-American background. The review found evidence in support of the use of DHIs in minority ethnic populations when specific factors are considered in implementation and design, including: patient beliefs and health needs; education and literacy levels; material circumstances; culture, social networks and the wider community; and supporting healthcare systems. CONCLUSIONS The CMOcs developed in this review provide a useful guide for the future development of DHIs targeted at South Asian and Black minority ethnic populations, with specific recommendations on improving cultural competency, and promoting accessibility and inclusivity of design.