“Cultural adaptation of DHI is an emerging area of research,” Nitas said. “Although we are seeing more and more adapted DHIs, there are still many uncertainties and challenges.”
Although cultural adaptations of DHI hold promise for reaching and engaging medically underserved populations, evidence of their effectiveness is lacking. A systematic review of 55 studies of DHI for mental disorders showed mixed results. In some cases, culturally adapted interventions do not show significant improvement over non-adapted counterparts, leading to questions about whether efforts to adapt DHI are worthwhile.
However, Nittas and Wray are cautious about drawing definitive conclusions from the existing body of evidence. “The number of currently available studies is small,” they write, “and their selected outcomes are heterogeneous. The majority of interventions lack theoretical guidance, suffer from high attrition rates, and fail to describe how the intervention is adapted.
Recognizing the need for further research, the team calls for the development of frameworks to guide the cultural adaptation of DHI. They emphasize the need to embed digital literacy in the cultural context to make these efforts more effective and accessible.
“The role of culture in how health technology is used cannot be overlooked,” Nitas said. “However, we still have a lot to learn about how to effectively adapt the DHI to ensure that people are not systematically left behind.”
A wider world of technology-based interventions
As the conversation around the digital divide and the need for culturally responsive digital health interventions gains momentum, Brown researchers have explored the broader context of technology’s relationship with health in a number of recent studies.
Tyler Ray, a clinical psychologist who is also the Edens Family Assistant Professor of Health and Technology at Brown, has led extensive work exploring how technology can be used to improve health behaviors. Some of his recent research explores the use of social media for public health, digital tools to improve medication adherence, and the application of virtual reality in the treatment of anxiety disorders.
A landmark study highlights the cost-effectiveness of targeted online advertising on platforms such as Google, Facebook and Instagram in engaging specific groups, such as people at high risk of HIV, for public health research. Although platforms like Jack’d, Grindr and TrafficJunky were effective in reaching the target audience, they incurred higher costs. Successful ads included eye-catching elements such as suggestive images and familiar logos, and emphasized the convenience of participating in surveys from home. The ads that resonate most with black and Hispanic men depict people of similar racial or ethnic backgrounds.
A key area of Wray’s work in the technology space involves using virtual reality to address anxiety disorders through a method known as virtual reality exposure therapy (VRET). Comparing VRET to traditional in vivo exposure therapy—a method that gradually introduces patients to their fears in real-world settings—Wray’s team rated 184 participants on their willingness, comfort, enthusiasm, and belief in the effectiveness of these therapies. The study showed a strong preference for VRET, with 90.2% of participants willing to try it, compared to 82% for in vivo therapy. Participants preferred VRET because of its perceived safety, privacy, and potential effectiveness, while concerns about in vivo therapy included the risk of exacerbating anxiety and discomfort.
Despite the demonstrated efficacy of VRET, its uptake among therapists remains limited, largely due to logistical hurdles and concerns about the overwhelming number of patients. Wray’s research advocates VRET as a valuable alternative to in vivo therapy, calling for further studies to accelerate its integration into clinical practice and alleviate therapists’ concerns.
Wray emphasizes the importance of support from clinics, professional organizations and insurers to encourage wider use of VRET. Such efforts aim to make this innovative treatment more accessible, providing therapists with a powerful tool to effectively manage anxiety disorders.