ReCODE Health

Purpose of Review: Novel and emerging digital health technologies are increasingly used in substance use and addiction-related self-management and treatment research. The promise of digital health is exciting, yet there are important factors regarding population characteristics to consider prior to using novel technologies with vulnerable populations. This paper reports a review of scientific literature published between 2015 and early 2020 on the use of digital health strategies in research focused on substance use and addiction in vulnerable populations.

Recent Findings: Using 13 search terms, three databases were screened for published literature meeting specific inclusion criteria. Common themes expressed across the 32 resulting publications included user acceptability, product reliability, and privacy and security concerns.

Summary: Implementation of evidence-based frameworks and guidelines is needed to guide future digital health research in vulnerable populations. Guidance should involve robust evaluations of acceptability, feasibility, and clinically meaningful use of digital health in diverse populations experiencing addiction-related health concerns.

Behavioral scientists are developing new methods and frameworks that leverage mobile health technologies to optimize individual level behavior change. Pervasive sensors and mobile apps allow researchers to passively observe human behaviors “in the wild” 24/7 which supports delivery of personalized interventions in the real-world environment. This is all possible because these technologies contain an incredible array of sensors that allow applications to constantly record user location and can contextualize current environmental conditions through barometers, thermometers, and ambient light sensors and can also capture audio and video of the user and their surroundings through multiple integrated high-definition cameras and microphones. These tools are a game changer in behavioral health research and, not surprisingly, introduce new ethical, regulatory/legal and social implications described in this article.

Background

In 2015, Collins and Varmus articulated a vision for precision medicine emphasizing molecular characterization of illness to identify actionable biomarkers to support individualized treatment. Researchers have argued for a broader conceptualization, precision health. Precision health is an ambitious conceptualization of health, which includes dynamic linkages between research and practice as well as medicine, population health, and public health. The goal is a unified approach to match a full range of promotion, prevention, diagnostic, and treatment interventions to fundamental and actionable determinants of health; to not just address symptoms, but to directly targetgenetic, biological, environmental, and social and behavioral determinants of health.

Purpose

The purpose of this paper is to elucidate the role of social and behavioral sciences within precision health.

Main body

Recent technologies, research frameworks, and methods are enabling new approaches to measure, intervene, and conduct social and behavioral science research. These approaches support three opportunities in precision health that the social and behavioral sciences could colead including: (a) developing interventions that continuously “tune” to each person’s evolving needs; (b) enhancing and accelerating links between research and practice; and (c) studying mechanisms of change in real-world contexts. There are three challenges for precision health: (a) methods of knowledge organization and curation; (b) ethical conduct of research; and (c) equitable implementation of precision health.

Conclusions

Precision health requires active coleadership from social and behavioral scientists. Prior work and evidence firmly demonstrate why the social and behavioral sciences should colead with regard to three opportunity and three challenge areas.