Digital Healthcare Interventions to Address the Secondary Health Effects of COVID-19 for Health Disparity and Vulnerable Populations

Presenter:

Susan Borja, Ph.D.
Division of Translational Research
Representing Trans-NIH Social, Behavioral, Economic Health Impacts of COVID-19, Particularly in Vulnerable and Health Disparity Populations Workgroup

Goal:

The intent of this trans-NIH initiative would be to invite research to determine the role and impact of digital health interventions (e.g., mobile health (mHealth), telemedicine and telehealth, health information technology, wearable devices) to address secondary health effects of the social, behavioral, and economic changes following the COVID-19 pandemic, particularly among populations who experience health disparities and other vulnerable populations (e.g., essential medical personnel, emergency responders, and frontline workers in essential businesses or services; people who are residents of chronic care facilities, community-dwelling older adults, pregnant, children, with cognitive impairment or dementia; homeless; incarcerated or involved with the criminal justice system, experiencing substance use disorder or serious mental illness; with disabilities including visual, hearing, communication, or mobility impairment; and the uninsured).

Rationale:

The COVID-19 pandemic has resulted in behavioral, social, and economic changes which impact health and are distinct from primary effects in those who contract SARS-CoV-2. Both new cases of disease as well as worsening of existing health problems are anticipated and may include mental illnesses, increased alcohol and substance use, suicidal thoughts and behaviors, sleep disturbances, chronic diseases/conditions (e.g., hypertension, diabetes, kidney disease, obesity) and related comorbidities. These adverse effects are compounded by pandemic-related disruptions in healthcare access, including access to allied health providers such as therapists and visiting nurses. Of particular concern is the NIH-designated health disparity populations  and other populations with medical or social vulnerabilities.

Digital health technology offers unprecedented opportunities to help consumers, clinicians, and researchers measure, manage, and improve health and productivity. These tools have the potential to improve our understanding of health status, to track the course of illnesses and recovery, and to provide and enhance health care. Digital health interventions aim to deliver treatment as a standalone intervention or as an adjunct to face-to-face interventions via a digital health platform (including mobile phone, website, virtual reality systems, and offline computer programs). Digital health interventions offer the potential to bridge the treatment gap and provide evidence-based interventions to the many individuals who currently are unable to access treatments.

The objective of this initiative would not be to simply support pragmatic trials on digital health platforms, but rather, to encourage research beyond primary effectiveness trials to capitalize on the unique features of digital health platforms. Such research might include but would not be limited to: analyses of baseline characteristics of users to develop treatment matching algorithms; analyses of existing data to determine the optimal sequence and dose of the digital intervention; and development and testing of real-time, adaptive, customized interventions that augment the base digital intervention.