Missing and masked: equity in a systematic review of remote interventions for substance misuse.

Session Type
Oral presentation
Global health and equity
Macdowall W1, D’Souza P2, Burchett H1, D’Souza P2, Sutcliffe K2
1Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, United Kingdom
2Eppi Centre, UCL, London, United Kingdom

Background: To reduce inequity, knowing whether interventions ‘work’ is not enough; we also need to know whether vulnerable sub-groups experience them differently. However, vulnerable groups may not have equal opportunity to participate in research and hence be under-represented or missing entirely, and unless study findings are reported by sub-group any differences among those included will be masked.
Objectives: As part of a systematic review (SR) exploring the effectiveness of remote therapies for drug/alcohol misuse, we undertook equity-related work with the objectives of understanding: 1) who was excluded from the research; 2) who was represented in the study populations; and 3) whether sub-groups experienced outcomes differently.
Methods: For each included primary study we assessed: 1) the exclusion criteria; 2) the socio-demographic characteristics reported using the PROGRESS-plus framework; and 3) whether substance use outcomes were reported by equity-relevant characteristics and, if so, whether there was any variation.
Results: 52 studies were included in the review, of which 47 had eligibility criteria with the potential to result in the exclusion of vulnerable sub-groups, most notably those with mental health conditions (MHCs) and those without access to digital technology. Few studies justified the exclusions or reported how many people were excluded on the basis of each criterion. Socio-demographic characteristics of the study populations were reported for all studies, though what characteristics and how they were measured varied. Most commonly and consistently reported were gender, age and ethnicity but it was rare that the study outcomes were reported by these or other factors.
Conclusions: The exclusion of certain vulnerable sub-groups from the research process, and lack of reporting of outcomes by potential axes of inequalities have important implications for the interpretation and generalizability of findings of SRs. Particularly troubling in our review was the frequency with which those with MHCs were excluded. Understanding how different groups experience interventions is key in order that practitioners can make informed decisions about their adoption in specific vulnerable groups and to ensure that interventions don’t inadvertently produce, or exacerbate, inequities.
Patient, public and/or healthcare consumer involvement: Advisory group from policy and practice inputted to all aspects of the SR.