Technology-based interventions for substance use treatment among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaskan Native: A scoping review (Preprint)

Abstract

In the United States, racial and ethnic disparities in substance use treatment outcomes are persistent, especially among African American/Black (AA/B), Hispanic/Latina/o (H/L), and American Indian/Alaskan Native (AI/AN) populations. Technology-based interventions (TBIs) for substance use treatment show promise in reducing barriers to evidence-based treatment, yet no studies have described how TBIs may impact racial and/or ethnic health equity.

This study explores whether TBIs in substance use treatment research promote health equity among people who identify as AA/B, H/L, and AI/AN through inclusion in research. Further, we explore whether research that does include the above groups consciously considers race and/or ethnicity beyond including these populations as participants.

We conducted a scoping review of five electronic databases (MEDLINE, Scopus, Cochrane Library, CINAHL, and PsycInfo) to identify TBIs in substance use treatment studies published in English between January 2000 to March 2021. Studies were included if at least 50% of participants identified as AA/B, H/L, and/or AI/AN when combined. Included studies were evaluated for conscious consideration of race and ethnicity in at least one manuscript section (e.g., methods). Last, we conducted a critical appraisal of each study’s potential to facilitate insights into the impact of a TBI for members of specific URM groups.

Of 6,897 titles/abstracts screened and 1,158 full-text articles assessed for eligibility, nearly half of the full-text articles were excluded due to the absence of data reported on race and or ethnicity, or not meeting demographic eligibility criteria referenced above. One hundred and ten studies met the inclusion criteria. Study designs included 43 randomized trials, 39 feasibility, 8 development, and 7 secondary analyses. Fifty-two (48%) studies utilized computer-based interventions, including electronic screening, brief intervention, and referral to treatment while 37 (34%) utilized interactive voice response, ecological momentary assessment/intervention, or text messaging intervention via mobile phones. Studies focused on the following substances: alcohol or drug use (n=45:41%), alcohol alone (n=26:24%), opioids (n=8:7%), cannabis (n=6:5%), cocaine (n=4:4%) and methamphetamine (n=3:3%). Twenty-nine studies (26%) consciously considered race and/or ethnicity, with 7 studies (6%) explicitly considering race and/or ethnicity in all manuscript sections. Thirty-one studies (28%) were critically appraised with higher confidence in the interpretability of findings for specific URM groups.

While the prevalence of TBIs in substance use treatment has increased in recent years, studies that include and consciously consider underrepresented minorities are rare, especially for AI/AN and H/L groups. This review highlights the limited research on TBIs in substance use treatment which promote racial and ethnic health equity, and provides context, insights, and direction for researchers working to develop and evaluate digital technology substance use interventions while promoting health equity.