Equity and behavioral digital health interventions: Strategies to improve benefit and reach

Abstract Background Behavioral digital health interventions (e.g., mobile apps, websites, wearables) have been applied widely to improve health outcomes. However, many groups (e.g., people with low income levels, people who are geographically isolated, older adults) may face obstacles to technology access and use. In addition, research has found that biases and stereotypes can be embedded within digital health interventions. As such, behavioral digital health interventions that intend to improve overall population health may unintentionally widen health-related inequities. Purpose This commentary offers guidance and strategies to mitigate these risks when using technology as a means for delivering a behavioral health intervention. Methods A collaborative working group from Society of Behavioral Medicine’s Health Equity Special Interest Group developed a framework to center equity in the development, testing and dissemination of behavioral digital health interventions. Results We introduce Partner, Identify, Demonstrate, Access, Report (PIDAR), a 5-point framework to avoid the creation, perpetuation, and/or widening of health inequities in behavioral digital health work. Conclusions It is critically important to prioritize equity when conducting digital health research. The PIDAR framework can serve as a guide for behavioral scientists, clinicians and developers. Lay Summary Behavioral digital health interventions have great potential to improve health. Unfortunately, many groups (e.g., people with low-income levels, people who are geographically isolated, older adults) may face significant obstacles to technology access, adoption and use. Additionally, research has found that biases and stereotypes can be embedded within digital health interventions. As such, behavioral digital health interventions that intend to improve overall population health may unintentionally widen health-related inequities. This commentary introduces the 5-point framework: Partner, Identify, Demonstrate, Access, Report (PIDAR) to be used in the development, testing and implementation of technology to avoid creating or worsening health inequities.