Use of Digital Health Interventions Among Forcibly Displaced People: A Systematic Review and Meta-Analysis.

Importance: Forcibly displaced people face significant biopsychosocial barriers to accessing health care. Digital health interventions have emerged as tools to bridge care gaps and have been successfully implemented in other disadvantaged populations to improve health care access and outcomes. However, the feasibility and practicality of digital health interventions among forcibly displaced individuals cannot be fully evaluated without characterizing recruitment and retention rates for these interventions in this unique population. Objective: To evaluate the recruitment rate and retention rate for digital health interventions in forcibly displaced people. Data Sources: A comprehensive search was conducted in PubMed, Web of Science, and SocINDEX in January 2023, with an updated search in February 2024. The search strategy followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was registered in PROSPERO. Study Selection: Only randomized clinical trials evaluating digital health interventions in forcibly displaced populations were included. Non-peer reviewed studies, reviews, and studies lacking recruitment or retention data were excluded. Two independent reviewers screened and selected studies, and conflicts were resolved by a third reviewer. Data Extraction and Synthesis: Data were extracted independently by 2 reviewers using Covidence, and a third reviewer resolved discrepancies. Meta-analysis was conducted using a random-effects model to estimate the pooled recruitment rate and retention rate. Study quality was assessed using the Downs and Black Checklist. Main Outcomes and Measures: Recruitment rate (percentage of prospective participants who were successfully randomized) and retention rate (percentage of randomized participants who completed the intervention). Results: A total of 9 randomized clinical trials with 2858 participants were analyzed. The most frequently investigated technology was mobile applications (4 trials), followed by mobile phones (3 trials), with 1 study utilizing tablets and another using wearables. Recruitment rates varied widely across studies (16% to 100%), as did retention rates (28% to 91%). The pooled recruitment rate was 91% (95% CI, 57%-99%; I2 = 99%), and the pooled retention rate was 68% (95% CI, 48%-84%; I2 = 98%). Conclusions and Relevance: In this systematic review and meta-analysis of 9 randomized clinical trials, forcibly displaced populations exhibited variable recruitment and retention rates, although pooled estimates were high. These findings suggest that digital technologies provide a unique opportunity for scalable health interventions in this population, which may mitigate the negative health consequences arising from the many biopsychosocial barriers to in-person care.