Digital health interventions to support women with opioid use disorder: A scoping review

Abstract

Background:

Digital health interventions have the potential to address barriers to care for women. To design effective digital health interventions that meet the needs of this population, a full assessment of the existing literature is required.

Methods:

This scoping review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. A total of four databases were searched: Medline (OVID), Embase, the Cumulative Index to Nursing and Allied Health Literature, and PsychInfo. Search terms were informed by a preliminary search and included synonyms for opioid use disorder, digital health, and women. Abstract screening and full text review was completed after reviewer calibration. Data extraction was carried out through data charting.

Results:

After removal of duplicates, 901 abstracts were screened; the full text of 26 manuscripts were reviewed. After full text review, 17 studies published between 2018 and 2023 were included in the scoping review. Types of digital health interventions and study designs varied widely, with a majority focused on the peripartum period (n=12). Of 11 studies focused on OUD treatment, only three reported outcomes related to MOUD utilization. Two studies described community engagement to inform the development or modification of interventions.

Conclusion:

A variety of digital health interventions are currently being used to address OUD among women. Areas for future work include examining efficacy for MOUD utilization, incorporating community engagement into intervention development, providing support for OUD treatment and recovery in the late postpartum period and beyond, and the development of mobile health applications.

1. Introduction

Between 1999 and 2021, the rate of opioid-related overdose among females increased from 1.4 to 14.5 per 100,000 population (National Institute on Drug Abuse, 2023). Although overall rates of opioid use disorder (OUD) are higher among males, the impact of OUD among women is unique in that it may extend to medical complications among their children (Weller et al., 2021). Between 2010 and 2017, rates of maternal opioid-related diagnoses increased more than 131% (3.5–8.2 per 1,000 delivery hospitalizations) and rates of neonatal abstinence syndrome (NAS), in which newborns experience withdrawal symptoms due to prenatal exposure to opioids, increased 82% (4.0–7.3 per 1,000 hospital births) (Hirai et al., 2021). NAS also places a significant economic burden on the healthcare system, with hospital costs for newborns with NAS estimated to be close to seven times higher than those for other newborns ($7,800 compared to $1,100) (Centers for Disease Control and Prevention, 2023).

Access to OUD treatment is not equitable and is especially challenging for women (Chopra & Marasa, 2017; Mazure & Fiellin, 2018; Office on Women’s Health, 2017; Terplan et al., 2015). NIDA notes that the barriers to seeking treatment for women include caretaking responsibilities, child custody concerns, and stigma (National Institute on Drug Abuse, 2020; Stringer & Baker, 2018). Women have lower rates of treatment utilization compared to men (Back et al., 2010). Furthermore, women with OUD are also more likely than men to be living with someone with a drug problem, living alone with children, financially dependent on others, and to have experienced sexual or physical abuse (Campbell et al., 2018). A women-centered approach to treatment and support for recovery is critical to meeting the needs of women with OUD and addressing gender-specific barriers to care across the life course.

While there is a lack of consensus around a definition for digital health (Fatehi et al., 2020), it can be broadly described as “tools and services that use information and communication technologies to improve prevention, diagnosis, treatment, monitoring and management of health-related issues and to monitor and manage lifestyle-habits that impact health” (European Commission). Digital health interventions have the potential to address some of the financial and social barriers to care for women, such as stigma, access to childcare, and lack of health insurance and/or transportation (Abebe et al., 2020; Guille et al., 2021; Harper, 2021; Johnston et al., 2019; Moreland et al., 2021). The onset of the COVID-19 pandemic led to a rapid expansion in the availability of both telehealth for addiction treatment and digital recovery support services. Longstanding regulations governing prescription practices related to medications for opioid use disorder (MOUD) were relaxed to allow providers to initiate and prescribe MOUD after virtual visits, and insurance coverage expanded to provide reimbursement to providers for these services (Guille et al., 2021; Kleykamp et al., 2020). Mutual-aid and recovery support groups also rapidly transitioned their meetings to virtual formats through teleconferencing applications. However, while digital health interventions have grown rapidly in recent years, their usability and acceptability has not been fully evaluated. Community engagement and consumer feedback are critical to designing and implementing digital health interventions that are most relevant to the needs of women. Furthermore, gendered barriers to OUD care intersect with additional social determinants of health that require full consideration during program development.

While previous reviews related to digital health, telemedicine, and mobile app technology for the treatment and support of people with OUD or people who use substances have been completed or are in progress (Bonfiglio et al., 2022; Chan et al., 2022; Crowley et al., 2020; Nuamah et al., 2020), they have not focused on women with OUD. To design effective digital health interventions that meet the needs of this population, a full assessment of the existing literature is required. The objective of this scoping review is to document and describe existing digital health interventions to support women with OUD. The secondary objective is to document the extent to which these digital health interventions have involved community engagement, addressed the social determinants of health, and solicited consumer feedback.

2. Methods

2.1. Search Strategy

This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) Checklist (Tricco et al., 2018). The protocol for this scoping review was registered on Open Science Framework and is available online (Ward et al., 2023).

The search strategy was developed in consultation with a health sciences librarian. A total of four databases were searched: Medline (OVID), Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsychInfo. Search terms were informed by a preliminary search of the literature and included synonyms for OUD, digital health, and women. Additional synonyms were added to the search strategy after conducting a thorough review of database-specific subject headings and glossaries. Where available, database-specific control language was included in each search. The full syntax for the search in Medline (OVID) is shown in Table 1; the syntax for the remaining three databases is available in the Supplement. All database searches were carried out on February 15, 2023.

Table 1.

Medline (OVID) search terms for a scoping review examining digital health interventions to support women with opioid use disorder

Synonyms for Opioid Use Disorder
(limit to abstracts) “opioid use disorder” OR heroin abuse OR heroin addict* OR heroin dependenc* OR heroin misuse OR heroin overdose OR morphine abuse OR morphine addict* OR morphine dependenc* OR morphine misuse OR morphine overdose OR opi* abuse OR opi* addict* OR opi* dependenc* OR opi* misuse OR opi* overdose* OR opioid epidemic OR opioid related disorder* OR opioid-related disorder* OR OUD OR opi* crisis
OR
(limit to abstracts) exp opioid-related disorders/ OR heroin dependence/ OR morphine dependence/ OR opiate overdose/OR opioid epidemic/
AND
Synonyms for Digital Health Technology
(limit to abstracts) biomedical software OR biotherapy software OR Cell phone OR cellular phone OR Computer assisted drug therapy OR Computer assisted therapy OR Computer-assisted drug therapy OR Computer-assisted therapy OR Digital health OR digital health intervention OR digital health resources OR digital health technology OR Digital health* OR Digital intervention* OR digital mental health resources OR distant monitoring OR distant patient monitoring OR eHealth OR electronic consultation OR Electronic health services OR hand held computers OR handheld computers OR hand-held computers OR healthcare software OR Internet based intervention OR Internet-based intervention OR laptop computer* OR laptop* OR mHealth OR Mobile app* OR Mobile health OR Mobile health application OR Mobile health technology OR mobile phone OR mobile phones OR mobile technology OR Mobile treatment OR online intervention OR online therapy OR patient surveillance OR personal digital assistant OR portable computers OR psychological software OR rehabilitation software OR remote consultation OR remote distance patient monitoring OR remote monitoring OR remote patient monitoring OR self-care software OR Smartphone OR tablet computers OR Telecare OR teleconferenc* OR teleconsultation OR telediagnosis OR Telehealth OR Telemedicine OR telemonitoring OR telenursing OR telepharmacy OR telephone OR Telepsychiatry OR Telepsychology OR Telerehabilitation OR telesurveillance OR teletherapy OR Text messag* OR Texting OR therapy software OR video conferencing OR video consultation OR video-based intervention OR videoconferenc* OR web based intervention OR web conferencing OR web-based intervention OR webcast OR webinar OR wireless communication OR wireless communications OR wireless technologies OR wireless technology
OR
(limit to abstracts) exp Cell Phone/ OR exp Drug Therapy, Computer-Assisted/ OR *Therapy, Computer-Assisted/ OR *Computers, Handheld/ OR *Mobile Applications/ OR Remote Consultation/ OR Smartphone/ OR *Telemedicine/ OR Telenursing/ OR *Telephone/ OR *Telerehabilitation/ OR *Text Messaging/ OR *Videoconferencing/ OR Webcast/ OR Wireless Technology/
AND
Synonyms for Women*
(limit to abstracts) femal* or mother* or pregnan* or woman or women
OR
(limit to abstracts) Female/ OR exp Mothers/ OR exp Pregnancy/ OR Pregnant Women/ OR exp Women/

^*Given the evolving use of language related to gender and sex, to be most inclusive, synonyms for women included terms related to both gender identity and sex assigned at birth. Terms related to pregnancy were also included as part of this concept, since much of the literature related to treating OUD among women focuses on the perinatal period.

An extensive list of 82 terms were included to account for the many types of technologies that may be considered digital health; these included (but are not limited to) synonyms for telemedicine and telehealth, mobile health and mobile health applications, text messaging, video conferencing, web-based care, and remote monitoring. Database-specific control language (for example, Medical Subject Headings in Medline or Emtree terms in Embase) was included when available as well. (See Table 1 and the Supplement for the full list of search terms and control language by database). Given the evolving use of language related to gender and sex, to be most inclusive, synonyms for women included terms related to both gender identity and sex assigned at birth. Terms related to pregnancy were also included as part of this concept, since much of the literature related to treating OUD among women focuses on the perinatal period.

Results from the four databases were imported into Covidence; duplicate articles were removed. Twenty-five abstracts were randomly selected and screened using the selection criteria to ensure alignment among the screening team (MW, AJ, TG, KP, PL). Screening of the remaining abstracts began after the team reached 75% or greater agreement with the principal investigator (MW). Article screening was then carried out in two stages. First, two reviewers independently screened abstracts for eligibility based on inclusion criteria. A third reviewer (MW) resolved any discrepancies. In the next stage, two reviewers conducted a full text review to determine final eligibility for inclusion. Any conflicts were resolved through discussion and consensus. The reference lists of articles selected for inclusion were screened manually for additional eligible studies.

2.2. Inclusion & Exclusion Criteria

An article was deemed eligible for inclusion in the scoping review if it met the following criteria: (1) described a digital health intervention to address OUD; (2) focused on providing support for individuals with OUD who identify as women or were assigned female at birth (including pregnant people); and (3) published in English within the last ten years (since 2013). Peer-reviewed articles and gray literature (e.g., conference proceedings) published in English (for feasibility reasons) were eligible for inclusion.

Articles were excluded if they did not describe a digital health intervention to address OUD, or did not focus on individuals who identified as women or were assigned female at birth. Additionally, articles weren’t eligible for inclusion if they were written in a language other than English or published before 2013. Because this was a scoping review, no exclusion criteria was applied based on study design.

2.3. Information Extraction

The primary objective of this scoping review is to describe digital health interventions that have been developed to support women with OUD. Descriptive information collected include the type of digital health intervention (e.g., text messaging, mobile phone application, telemedicine visit); the type of interaction involved (e.g., synchronous or asynchronous); whether these interventions focused primarily on treatment or prevention; and the health outcomes measured.

The scoping review also documents if community engagement was part of digital health intervention development, and if consumer feedback was collected after development. If community engagement activities were incorporated during development, these activities were classified according to the continuum of community-engaged research interactions as proposed by Sanders Thompson and colleagues (2021). Finally, the scoping review documented if digital health interventions to support women with OUD addressed social determinants of health, such as access to care and socioeconomic status. Data extraction was carried out through the process of data charting, as described by the JBI guidance on scoping reviews (Peters et al., 2020).

2.4. Screening Process

Figure 1 shows the PRISMA flowchart of the search and screening process. A total of 1,213 references resulted from the initial database search; 314 duplicates were removed. Two additional references resulted from manual screening of reference lists. The 901 resulting abstracts were published in English. Abstract screening was carried out by the review team (MW, AJ, TG, KP, PL). During screening, proportionate agreement between reviewer pairs was 84% or higher. At the completion of abstract screening, 26 studies were deemed eligible for full text review. After full text review, a total of 17 studies were included in the scoping review. All were published between 2018 and 2023.

Figure 1.

PRISMA flowchart, results of a scoping review examining digital health interventions to support women with opioid use disorder

3. Results

Tables 2, 3, and 4 provide detailed descriptions of the 17 publications included and results from data charting. A majority of studies focused on the peripartum period (n=12); the remaining studies focused on justice-involved women (n=2) (Staton et al., 2021; Tillson et al., 2022), women residing in a supportive housing facility (n=1) (Bardwell et al., 2021), women enrolled in MOUD program sites (n=1) (Jones et al., 2021), and women visiting community sites that offer OUD-supportive services (Thompson et al., 2020). Interventions specific to the reproductive needs of women with OUD included telesupport for reproductive health clinicians (n=1) (Forray et al., 2022), computer-adapted contraceptive counseling (n=1) (Jones et al., 2021), and access to reproductive care providers via telehealth (n=1) (Thompson et al., 2020).

Table 2.

Results of a scoping review examining digital health interventions to support women with opioid use disorder: Publication details and study objectives

Authors	Title	Journal	Year	Publication Type & Link	Study Objective	Funding Source
Bardwell, G., Fleming, T., McNeil, R., Boyd, J. (Bardwell et al., 2021)	Women’s multiple uses of an overdose prevention technology to mitigate risks and harms within a supportive housing environment: A qualitative study	BMC Women’s Health	2021	Peer-reviewed article https://doi.org/10.1186/s12905-021-01196-6	“To examine the experiences of women utilizing [overdose response button] technology within a Women-only supportive housing environment.”	Canadian Institutes of Health Research (PJT-162290 and PJT-155943), National Institutes of Health (R01DA044181), Michael Smith Foundation for Health Research, St. Paul’s Foundation/British Columbia Centre on Substance Use
Critchfield, A.S. (Critchfield, 2018)	PATHways: Comparative Effective ness Study of Peripartum Opioid Use Disorder in Rural Kentucky	Journal of Women’s Health	2018	Abstract from the NIH Office of Research on Women’s Health 2018 Annual BIRCWH Meeting: https://doi.org/10.1089/jwh.2018.29020.abstracts Additional information retrieved from: https://clinicaltrials.gov/study/NCT03725332	“To determine the optimal method for delivery of perinatal OUD support services to mothers receiving Medication Assisted Therapy (MAT) for OUD in rural settings.”	Patient-Centered Outcomes Research Institute
Forray, A., Mele, A., Byatt, N., Londono Tobon, A., Gilstad-Hayden, K., Hunkle, K., Hong, S., Lipkind, H., Fiellin, D.A., Callaghan, K., Yonker s, K.A. (Forray et al., 2022)	Support Models for Addiction Related Treatment (SMART) for pregnant women: Study protocol of a cluster randomized trial of two treatment models for opioid use disorder in prenatal clinics.	PLoS One	2022	Study protocol https://doi.org/10.1371/journal.pone.0261751	“To describe the Support Models for Addiction Related Treatment (SMART) trial, a matched pair cluster-randomized clinical trial protocol to compare two support models (collaborative care vs. Project Extension for Community Healthcare Outcomes) that provide buprenorphine education and support for providers caring for pregnant patients with OUD.”	Patient Centered Outcomes Research Institution (MAT-2018C2-12891)
Guille, C., Simpson, A.N., Douglas, E., Boyars, L., Cristaldi, K., McElligott, J., Johnson, D., Brady, K. (Guille et al., 2020)	Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine: A Nonrandomized Controlled Trial	JAMA Network Open	2020	Peer-reviewed article https://doi.org/10.1001%2Fjamanetworkopen.2019.20177	“To compare maternal and newborn outcomes among pregnant women with OUD receiving care via telemedicine vs in person.”	National Institute on Drug Abuse (R34 DA046730 ), Duke Endowment (6563-SP), Health Resources and Services Administration as part of the National Telehealth Center of Excellence Award (U66 RH31458)
Harper, L.M. (Harper, 2021)	Telehealth Approaches to Improve Opioid Use Care in Pregnancy	Clinical Obstetrics & Gynecology	2021	Peer-reviewed article https://doi.org/10.1097/grf.0000000000000607	Presents a case study of using telemedicine to provide OUD care during pregnancy and discusses lessons learned	Society of Maternal-Fetal Medicine Aetna Health Policy Grant
Johnston, D.C., Mathews, W.D., Maus, A., Gustafson, D.H. (Johnst on et al., 2019)	Using Smartphones to Improve Treatment Retention Among Impoverished Substance-Using Appalachian Women: A Naturalistic Study	Substance Abuse: Research and Treatment	2019	Peer-reviewed article https://doi.org/10.1177/1178221819861377	“To evaluate whether an evidence-based relapse-prevention smartphone system… could increase retention in treatment among women with SUDs in an isolated, impoverished rural setting.”	Substance Abuse and Mental Health Services Administration (TI023831)
Jones, H.E., Martin, C.E., Andringa, K.R., Middlesteadt Ellerson, R., Johnson, E., Hairston, E., O’Grady, K.E. (Jones et al., 2021)	Sex and female empowerment (SAFE): A randomized trial comparing sexual health interventions for women in treatment for opioid use disorder	Drug and Alcohol Dependence	2021	Peer-reviewed article https://doi.org/10.1016/j.drugalcdep.2021.108634	“To evaluate the feasibility, acceptability, and efficacy of” two Sex and Female Empowerment (SAFE) interventions (computer-adapted and face-to-face) “relative to each other and compared to usual care”	National Institute on Drug Abuse (R34 DA033442)
Liang, O.S., Chen, Y., Bennett, D.S., Yang, C.C. (Liang et al., 2021)	Identifying Self-Management Support Needs for Pregnant Women With Opioid Misuse in Online Health Communities: Mixed Methods Analysis of Web Posts	Journal of Medical Internet Research	2021	Peer-reviewed article https://doi.org/10.2196/18296	“To identify the characteristics of women in an online health community (OHC) with opioid use or misuse during pregnancy and the self-management support needs of these mothers.”	National Science Foundation (NSF-1741306, IIS-1650531, and DIBBS-1443019)
McKiever, M.E., Cleary, E.M., Schmauder, T., Talley, A., Hinely, K.A., Costantine, M.M., Rood, K.M. (McKiever et al., 2020)	Unintended consequences of the transition to teleheath for pregnancies complicated by opioid use disorder during the coronavirus disease 2019 pandemic	American Journal of Obstetrics & Gynecology	2020	Peer-reviewed article https://doi.org/10.1016/j.ajog.2020.08.003	To report “experience with implementation of telehealth services for a cohort of pregnant women with OUD” during the onset of the COVID-19 pandemic	None described
Moreland, A., Guille, C., McCauley, J.L. (Moreland et al., 2021)	Increased availability of telehealth mental health and substance abuse treatment for peripartum and postpartum women: A unique opportunity to increase telehealth treatment	Journal of Substance Use & Addiction Treatment	2021	Peer-reviewed article https://doi.org/10.1016/j.jsat.2020.108268	Describe lessons learned during the conversion of Screening and treatment for mental health and substance use disorders among pregnant patients to remote platforms during the onset of the COVID-19 pandemic	National Institute on Drug Abuse (R34 DA046730)
Patton, E.W., Saia, K., Stein, M.D. (Patton et al., 2021)	Integrated substance use and prenatal care delivery in the era of COVID-19	Journal of Substance Use & Addiction Treatment	2021	Peer-reviewed article https://doi.org/10.1016/j.jsat.2020.108273	Describe the hybrid telemedicine/in-person prenatal care model implemented during COVID-19 for pregnant patients with OUD	None described
Rohrbaugh, F.M., Plessinger, L. (Rohrbaugh et al., 2019)	Motivational Interviewing by Phone in Postpartum Women with an Opiate Use Disorder	Journal of Addiction Medicine	2019	Abstract from the 2019 ASAM Annual Conference: https://doi.org/10.1097/ADM.0000000000000548 Additional information retrieved from: https://www.eventscribe.com/2019/posters/ASAM/PosterViewer.asp?PID=MzcwNzEyNjY1MjE#	“To implement Motivational Interviewing (MI) delivered by phone to postpartum women with an Opiate Use Disorder (OUD) to reduce relapse rates and improve retention in treatment for the first 8 weeks postpartum.”	Pennsylvania Coordinated Medically-Assisted Treatment Grant, RFA Number 67–62, awarded October 2017
Smarony, S., Parlier-Ahmad, A.B., Shadowen, H., Thakkar, B., Scheikl, M.O., Martin, C.E. (Smarony et al., 2022)	Assessment of COVID-19-Driven Changes in an Integrated OBGYN-Addiction Treatment Clinic and Future Implications	Journal of Addiction Medicine	2023	Peer-reviewed article https://doi.org/10.1097/adm.0000000000001122	“To (1) describe COVID-19-driven changes in clinical practices used by an integrated, interdisciplinary OBGYN-addiction clinic; (2) evaluate clinic-level medical provider visit attendance patterns across 3 defined phases of the COVID-19 pandemic; and (3) compare patient-level SUD treatment engagement outcomes among a cohort of pregnant and parenting people receiving buprenorphine for OUD across 3 COVID-19 pandemic phases.”	Jeanann Gray Dunlap Foundation, National Center for Advancing Translational Sciences (CTSA award no. UL1TR002649), National Institute on Drug Abuse (T32DA00 7027, K23 DA053507), VCU Undergraduate Fellowship for Clinical and Translational Research
Staton, M., Webster, J.M., Leukefeld, C., Tillson, M., Marks, K., Oser, C., Bush, H.M., Fanucchi, L., Fallin-Bennett, A., Garner, B.R., McCollisteri, K., Johnson, S., Winston, E. (Staton et al., 2021)	Kentucky Women’s Justice Community Opioid Innovation Network (JCOIN): A type 1 effectiveness-implementation hybrid trial to increase utilization of medications for opioid use disorder among justice-involved women	Journal of Substance Use & Addiction Treatment	2021	Study protocol https://doi.org/10.1016/j.jsat.2021.108284	To “compare the effectiveness of (1) MOUD pretreatment telehealth alone and (2) MOUD pretreatment telehealth with peer navigation to (3) services as usual (SAU) to increase MOUD initiation among justice-involved women post-release; estimate the increment al cost and cost-effectiveness of MOUD pretreatment telehealth (alone and with peer navigation) relative to SAU; and examine changes in constructs hypothesized by the exploration, preparation, implementation, and sustainment (EPIS) framework as being associated with successful innovation implementation.”	National Institutes of Health through the NIH HEAL Initiative (UG1DA050069)
Thompson, T., Ahrens, K.A., Coplon, L. (Thompson et al., 2020)	Virtually possible: using telehealth to bring reproductive health care to women with opioid use disorder in rural Maine	mHealth	2020	Peer-reviewed article https://doi.org/10.21037/mhealth-19-237	To “examine the feasibility of a program that aimed to help women with OUD in Maine meet their reproductive health needs by bringing services directly to them through the use of community outreach educators and telehealth.”	None
Tillson, M., Fallin-Bennett, A., Staton, M. (Tillson et al., 2022)	Providing peer navigation services to women with a history of opioid misuse pre- and post-release from jail: A program description	Journal of Clinical and Translational Science	2022	Peer-reviewed article https://doi.org/10.1017/cts.2022.441	“To (1) outline goals, supports, and barriers to treatment access identified by incarcerated women with OUD before release from jail; (2) describe women’s transition to the community from the perspectives of peer navigators; and (3) discuss intervention challenges, successes, and lessons learned identified by peer navigators during the first year of study implementation.”	National Institute on Drug Abuse, National Institutes of Health, through the NIH HEAL Initiative (UG1DA05 0069)
White, A., Lundahl, B., Bryan, M.A., Okifuji, A., Smid, M., Gordon, A.J., Carlston, K., Silipigni, J., Abdullah, W., Krans, E.E., Kenney, A., Cochran, G. (White et al., 2022)	Pregnancy and the Opioid Crisis: Heightened Effects of COVID-19	Journal of Addiction Medicine	2022	Peer-reviewed article https://doi.org/10.1097/adm.0000000000000822	To “discuss unintended consequences faced by” pregnant patients with OUD and “offer key insights that may be useful to researchers and clinicians across the U.S. serving this population.”	None described

Table 3. Results of a scoping review examining digital health interventions to support women with opioid use disorder: Study settings, samples, and designs and types of digital health interventions.

Article	Article Link	Study Setting	Study Sample	Study Design	Type of Digital Health Intervention	Type of Interaction
Bard well et al., 2021	https://doi.org/10.1186/s12905-021-01196-6	Women -only supportive housing Vancouver, Canada	14 women residents, ages 30–55 (average age: 39)	Qualitative semi-structured in-depth interviews	Wireless overdose response button (sends notification to a cellular phone monitored by staff)	Synchronous
Critchfield, 2018	Abstract from the NIH Office of Research on Women’s Health 2018 Annual BIRCWH Meeting: https://doi.org/10.1089/jwh.2018.29020.abstracts Additional information retrieved from: https://clinicaltrials.gov/study/NCT03725332	Perinatal care sites in Central and Eastern Kentucky	Pregnant women receiving MOUD, ages 18–55 (estimated enrollment: 533)	Randomized cluster trial	Telemedicine patient education (compared to group care education)	Synchronous
Forray et al., 2022	https://doi.org/10.1371/journal.pone.0261751	Obstetric clinics in Connecticut and Massachusetts	Obstetric patients served by 8 clinics in Connecticut and 4 in Massachusetts, at least 18 years of age, and less than 34 weeks pregnant at the time of enrollment (estimated 1,075 eligible participants)	Protocol for a matched-pair randomized clinical trial	Telesupport model (via videoconferencing) for reproductive health providers: Project Extension for Community Healthcare Outcomes (ECHO), a telesupport remote education model (compared to collaborative care, based on the Massachusetts Office-Based-Opioid Treatment model)	Synchronous
Guille et al., 2020	https://doi.org/10.1001%2Fjamanetworkopen.2019.20177	Outpatient obstetric practice s in South Carolina	98 women (mean age=30. 23 years) from 4 outpatient obstetric practices (telemedicine: n=44, in-person: n=54)	Nonran domized controlled trial	Telemedicine delivery of OUD care/MOUD for obstetric patients (compared to in-person visits)	Synchronous
Harper, 2021	https://doi.org/10.1097/grf.0000000000000607	University of Alabama at Birmingham’s Comprehensive Addiction in Pregnancy Program	Pregnant women (sample size unspecified)	Case study	Telemedicine delivery of OUD care/MOUD for obstetric patients	Synchronous
Johnston et al., 2019	https://doi.org/10.1177/1178221819861377	Southeastern Kentucky	Women ages 18 to 40 years, who reported having children or being pregnant, were referred from child welfare agencies, drug courts, or other criminal justice agencies, and were mandated to treatment (intervention: n=98; non-equivalent control: n=100)	Quasi-experimental study (naturalistic, non-equivalent control group)	Smartphone-based relapse-prevention system: Addiction-Comprehensive Health Enhancement Support System (A-CHESS)	Asynchronous
Jones et al., 2021	https://doi.org/10.1016/j.drugalcdep.2021.108634	Two clinics in urban areas of central North Carolina	90 women (3 arms, each arm n=30) ages 18 to 40, enrolled in MOUD program sites and stabilized for 90 days, not pregnant and no plans to become pregnant, no sterilization, heteros exual sexual orientation	Randomized controlled trial	Computer-adapted Sex and Female Empowerment (SAFE) intervention	Synchronous
Liang et al., 2021	https://doi.org/10.2196/18296	Online forum	200 randomly sampled, anonymized web posts, posted from 2000–2019	Qualitative inductive thematic analysis	Online health communities for pregnant women with OUD	Asynchronous
McKiever et al., 2020	https://doi.org/10.1016/j.ajog.2020.08.003	Office-based outpatient practice in Ohio providing maternal fetal medicine and addiction care for pregnant women with OUD	13 pregnant patients enrolled in obstetrical OUD care with stable MOUD dosing at least 4 weeks before the onset of the COVID-19 pandemic in Ohio	Cohort study	Virtual group therapy sessions	Synchronous
Morel and et al., 2021	https://doi.org/10.1016/j.jsat.2020.108268	The Medical University of South Carolina’s Women’s Reproductive Behavioral Health Program	Pregnant women (sample size unspecified)	Program description	Online or text-message-based screening; home-based telehealth visits with specialists in reproductive psychiatry	Asynchronous and synchronous
Patton et al., 2021	https://doi.org/10.1016/jjsat.2020.108273	The Recovery, Empowerment, Social Services, Prenatal care, Education, Community and Treatment Clinic, Boston Medical Center	90 Patients currently enrolled in integrated prenatal and substance use disorder care (including OUD; 87% on MOUD)	Program description	Hybrid telemedicine/in-person prenatal and substance use disorder (including OUD) care	Synchronous
Rohrbaugh et al., 2019	Abstract from the 2019 ASAM Annual Conference: https://doi.org/10.1097/ADM.0000000000000548 Additional information retrieved from: https://www.eventscribe.com/2019/posters/ASAM/PosterViewer.asp?PID=MzcwNzEyNjY1MjE#	580-bed teaching hospital in South Central Pennsylvania	33 postpartum women with OUD (16 in intervention arm, 17 in comparison group)	Cohort study	Telephone-delivered motivational interviewing (compared to care as usual)	Synchronous
Smarony et al., 2023	https://doi.org/10.1097/adm.0000000000001122	An “OB/GYN-addiction outpatient treatment clinic, affiliated with a large academic medical center in a Medicaid-expanded southern state”	27 pregnant and parenting people receiving buprenorphine for OUD, mean (SD) age of 31 (4.0)	Mixed methods; cohort study at the patient level	Hybrid virtual/in-person medical care; virtual behavioral health services	Synchronous
Staton et al., 2021	https://doi.org/10.1016Zj.jsat.2021.108284	9 county jails in Kentucky	900 women with OUD will be recruited (600 to the two intervention arms, 300 to the control group)	Protocol for a type 1 effectiveness-implementation hybrid trial	MOUD pretreatment telehealth and MOUD pretreatment telehealth with peer navigation (includes telephone sessions with peer navigators), compared to state-supported services as usual	Synchronous
Thompson et al., 2020	https://doi.org/10.21037/mhealth-19-237	12 community sites offering OUD-supportive services in 8 counties in Maine	15 women ages 22–50, with a median age of 39, received reproductive services via telehealth; 51 women ages 18–50 engaged in interactions with community outreach educator	Pilot feasibility study	Telehealth services from family planning clinics, accessed through community sites	Synchronous
Tillson et al., 2022	https://doi.org/10.1017/cts.2022.441	6 county jails in Kentucky (4 experimental and 2 comparison sites)	52 Formerly incarcerated women with OUD transitioning to the community, ages 21–57, average age 36.5	Qualitative content analysis	Peer navigation services via teleconference or telephone	Synchronous
White et al., 2022	https://doi.org/10.1097/adm.0000000000000822	Utah and Pennsylvania	Pregnant women with OUD (sample size and age unspecified)	Commentary on ongoing clinical trial	Hybrid virtual/in-person patient navigation services	Synchronous

Table 4. Results of a scoping review examining digital health interventions to support women with opioid use disorder: Primary focus, outcomes measured, social determinants of health addressed, and inclusion of community engagement and consumer feedback.

Article	Article Link	Primary Focus	Outcomes Measured	Social Determinants of Health Addressed	Community Engagement in Intervention Development?	Type of Community Engagement	Inclusion of Consumer Feedback
Bardwell et al., 2021	https://doi.org/10.1186/s12905-021-01196-6	Treatment of overdose	Experiences with overdose response button technology	Housing environment, gender-based violence	Unclear in relation to intervention development; peer research assistants and women with lived experience assisted with interview guide development; a peer research assistant assisted with recruitment and data collection	Consultation	Feedback collected through qualitative participant interviews
Critchfield, 2018	Abstract from the NIH Office of Research on Women’s Health 2018 Annual BIRCWH Meeting: https://doi.org/10.1089/jwh.2018.29020.abstracts Additional information retrieved from: https://clinicaltrials.gov/study/NCT03725332	Treatment of OUD	Neonatal abstinence syndrome requiring medication, maternal relapse, maternal-infant dyad status, smoking cessation, additional outcomes related to OUD and maternal/infant health	Geographic access to care	None described	N/A	None described
Forray et al., 2022	https://doi.org/10.1371/journal.pone.0261751	Treatment of OUD	Engagement (>2 visits in 30 days) and retention in OUD treatment, patient activation, additional secondary outcomes including number/percent offered, initiated, retained on MOUD, and continuing MOUD postpartum	Availability of OUD care	None described	N/A	Qualitative interviews with providers and patients are planned
Guille et al., 2020	https://doi.org/10.1001%2Fjamanetworkopen.2019.20177	Treatment of OUD	Primary outcome: Retention in treatment 6–8 weeks postpartum (defined as uninterrupted treatment with buprenorphine and at least monthly visits with prescribing psychiatrist); Secondary outcomes: urine drug screen results, neonatal abstinence syndrome diagnosis	Geographic access to OUD care	None described	N/A	None described
Harper, 2021	https://doi.org/10.1097/grf.0000000000000607	Treatment of OUD	Perinatal outcomes are part of the pilot study, but no outcome results reported in this case study	Access to OUD care, stigma	None described	N/A	None described
Johnston et al., 2019	https://doi.org/10.1177/1178221819861377	Treatment of OUD	Retention in treatment (length of stay), utilization of units of clinical service	Geographic access to OUD care, access to digital devices and resources	None described	N/A	Feedback collected through a short survey sent to participant after the study
Jones et al., 2021	https://doi.org/10.1016/j.drugalcdep.2021.108634	Prevention of unintended pregnancy	Feasibility (intervention completion, intervention satisfaction) and efficacy (contraception consultation attendance, receipt of long-acting reversible contraception)	Access to contraceptive care	Content of the SAFE intervention developed from qualitative interviews and pilot-testing feedback from women in treatment for OUD	Consultation	Feedback on satisfaction collected through one survey item after each intervention session
Liang et al., 2021	https://doi.org/10.2196/18296	Treatment of OUD	Themes related to managing opioid use during pregnancy, including recovery, self-management support, self-managed withdrawal, MOUD tapering, and emotional needs	Stigma, access to OUD care	None described	N/A	None described
McKiever et al., 2020	https://doi.org/10.1016/j.ajog.2020.08.003	Treatment of OUD	Group therapy attendance, uptitration of MOUD, urine drug screen, additional treatment measures	Access to OUD care during the COVID-19 pandemic	None described	N/A	Participants were asked their reasons for not attending virtual group therapy sessions
Moreland et al., 2021	https://doi.org/10.1016/j.jsat.2020.108268	Treatment of mental health and substance use disorders (including OUD)	None described	Access to mental health and substance use disorder (including OUD) care during the COVID-19 pandemic, access to digital devices, interpersonal violence	None described	N/A	None described
Patton et al., 2021	https://doi.org/10.1016/j.jsat.2020.108273	Treatment of OUD, prenatal care	No-show rates, full evaluation of number of pregnant patients seeking methadone initiation and titration planned	Access to OUD care during the COVID-19 pandemic	None described	N/A	Informal conversations with providers; mixed-methods evaluation of patient experiences planned
Rohrbaugh et al., 2019	Abstract from the 2019 ASAM Annual Conference: https://doi.org/10.1097/ADM.0000000000000548 Additional information retrieved from: https://www.eventscribe.com/2019/posters/ASAM/PosterViewer.asp?PID=MzcwNzEyNjY1MjE#	Treatment of OUD	Treatment retention (rate of attendance at both postpartum and behavior al health visits), relapse (self-reported drug use within past 7 days)	Access to OUD care	None described	N/A	Information on speed of admission to detox received verbally from women in intervention arm
Smarony et al., 2023	https://doi.org/10.1097/adm.0000000000001122	Treatment of OUD	Clinic level: Qualitative descriptions of clinical changes due to COVID-19, monthly number of medical provider visits Patient level: buprenorphine continuation, total visit attendance, medical provider and behavioral health visits, proportion of virtual visits	Access to OUD care during the COVID-19 pandemic	None described	N/A	None described
Staton et al., 2021	https://doi.org/10.1016/j.jsat.2021.108284	Treatment of OUD	Community MOUD initiation, medication type, community treatment retention (measured at 3, 6, and 12 months), incremental cost, cost-effectiveness	Access to OUD care, involvement with the criminal justice system	None described	N/A	Focus groups with key stakeholders and staff are planned
Thompson et al., 2020	https://doi.org/10.21037/mhealth-19-237	Prevention (unintended pregnancy & STIs) and treatment (pregnancy & HIV counseling)	Number of women engaged and receiving reproductive services via telehealth, contraceptive methods received on-site, referrals, follow-up appointments attended during 6-month period	Access to reproductive health services	None described	N/A	None described
Tillson et al., 2022	https://doi.org/10.1017/cts.2022.441	Treatment of OUD	Reentry recovery domains (n=29 asked about interest in MOUD), primary post-release goal, recovery capital, peer navigators’ reflections on program implementation	Access to OUD care, involvement with the criminal justice system, access to resources	None described	N/A	None described
White et al., 2022	https://doi.org/10.1097/adm.0000000000000822	Treatment of OUD	Description of the research team’s approaches to protecting patient safety due to intimate partner violence improving communication, providing access to resources, and addressing increased overdose risk	Intimate partner violence, access to OUD care during the COVID-19 pandemic, poverty and access to resources	None described	N/A	None described

Table 2 includes publication title, journal, year of publication, publication type (e.g. peer-reviewed article, abstract, study protocol), study objective, and funding source. Fourteen articles (82%) were published in 2020 or later; five addressed challenges related to COVID-19 (McKiever et al., 2020; Moreland et al., 2021; Patton et al., 2021; Smarony et al., 2022; White et al., 2022). Two publications were protocols for ongoing studies (Forray et al., 2022; Staton et al., 2021), and two were abstracts for conference presentations (Critchfield, 2018; Rohrbaugh et al., 2019). Major funding agencies included the National Institute on Drug Abuse, the National Institutes of Health Helping to End Addiction Long-term Initiative, the National Center for Advancing Translational Sciences, the Substance Abuse and Mental Health Services Administration, the Patient-Centered Outcomes Research Institute, the National Science Foundation, and the Canadian Institutes of Health Research.

Table 3 describes study setting and sample, study design, type of digital health intervention, and type of interaction (e.g. synchronous or asynchronous). Most studies occurred in the Southern U.S. (n=9), including Kentucky, North Carolina, South Carolina, and Alabama. Other study settings included the Northeast (n=5; Pennsylvania, Massachusetts, Connecticut, and Maine) (Forray et al., 2022; Patton et al., 2021; Rohrbaugh et al., 2019; Thompson et al., 2020; White et al., 2022), the Midwest (n=1; Ohio) (McKiever et al., 2020), the Mountain West (n=1; Utah) (White et al., 2022), British Columbia, Canada (n=1) (Bardwell et al., 2021), and an online environment (n=1) (Liang et al.; 2021). Study designs included program descriptions (n=2) (Moreland et al., 2021; Patton et al., 2021), commentary (n=1) (White et al., 2022), qualitative analyses (n=3) (Bardwell et al., 2021; Liang et al., 2021; Tillson et al., 2022), mixed-methods (n=1) (Smarony et al., 2023), case study (n=1) (Harper, 2021), cohort studies (n=3) (McKiever et al., 2020; Rohrbaugh et al., 2019; Smarony et al., 2023), a pilot feasibility study (n=1) (Thompson et al., 2020), a quasi-experimental design (n=1) (Johnston et al., 2019), nonrandomized (n=1) (Guille et al., 2020) and randomized trials (n=3) (Critchfield, 2018; Forray et al., 2022; Jones et al., 2021), and an effectiveness-implementation hybrid trial (n=1) (Staton et al., 2021).

Interventions varied widely and included telemedicine or virtual services for OUD treatment or behavioral health care (n=4) (Guille et al., 2020; Harper, 2021;McKeiver et al., 2020; Moreland et al., 2021), telesupport for reproductive health providers (n=1) (Forray et al., 2022), and virtual patient education (n=1) (Critchfield, 2018), as well as hybrid virtual/in-person medical care (n=2) (Patton et al., 2021; Smarony et al., 2023) and patient navigation (n=1) (White et al., 2022). Technologies also ranged widely, including wireless overdose response buttons (n=1) (Bardwell et al., 2021), online health communities (n=1) (Liang et al., 2021), text messaging (n=1) (Moreland et al., 2021), teleconference or telephone-based peer navigation (n=2) (Staton et al., 2021; Tillson et al., 2022), telephone-delivered motivational interviewing (n=1) (Rohrbaugh et al., 2019), and a smartphone-based relapse-prevention system (n=1) (Johnston et al., 2019). A majority of studies (n=14) described synchronous interactions with providers; only three included asynchronous interactions (Johnston et al., 2019; Liang et al., 2021; Moreland et al., 2021). Detailed descriptions can be found in Table 3.

Table 4 describes outcomes measured, social determinants of health addressed, information provided related to community engagement, and whether studies mentioned the inclusion of consumer feedback. The outcomes of interest varied across studies and included retention in treatment or provider visit attendance (n=8), MOUD initiation (n=2) (Patton et al., 2021; Staton et al., 2021), MOUD continuation (n=1) (Smarony et al., 2023), urine drug screen results (n=2) (Guille et al., 2020; McKiever et al., 2020), and occurrence of neonatal abstinence syndrome (n=2) (Critchfield, 2018; Guille et al., 2020). Fourteen studies focused on treatment of OUD, one focused on treatment of opioid-related overdoses (Bardwell et al., 2021), and two focused on prevention of unintended pregnancies or sexually transmitted infections (Jones et al., 2021; Thompson et al., 2020). Of the 14 publications focusing on OUD treatment, two were study protocols (Forray et al., 2022; Staton et al., 2021) and one study was ongoing (Tillson et al., 2022). Of the remaining 11 studies focused on OUD treatment, only three reported outcomes related to MOUD treatment regimens: Guille et al. (2020) included treatment with buprenorphine in their measure of treatment retention within the context of a nonrandomized controlled trial; McKiever et al. (2020) measured uptitration of MOUD in their cohort study; and Smarony et al. (2023) examined patient-level buprenorphine continuation in their mixed-methods study.

As shown in Table 4, the social determinant of health most frequently addressed with digital intervention was access to care (n=15), with three studies specifically mentioning their rationale as addressing geographic disparities in access to care for women in rural settings (Critchfield, 2018; Guille et al., 2020; Johnston et al., 2019). Five studies addressed barriers to care for OUD that resulted from the COVID-19 pandemic when women were unable to attend visits in person (McKiever et al., 2020; Moreland et al., 2021; Patton et al., 2021; Smarony et al., 2023; White et al., 2022). Other social determinants of health that were addressed included interpersonal violence (n=3) (Bardwell et al., 2021; Moreland et al., 2021; White et al., 2022), the housing environment (n=1) (Bardwell et al., 2021), poverty and access to resources (n=4) (Johnston et al., 2019; Moreland et al., 2021; Tillson et al., 2022; White et al., 2022), stigma (n=2) (Harper, 2021; Liang et al., 2021), and involvement with the criminal justice system (n=2) (Staton et al., 2021; Tillson et al., 2022).

Studies took a variety of approaches to addressing these issues. In their study examining overdose response button technology within a supportive housing environment, Bardwell and colleagues (2021) noted the buttons were also used when women experienced emergencies related to gender-based violence. Also addressing interpersonal violence, White et al. (2022) described using in-person visits to select a code word women can use during virtual visits to indicate they are in an unsafe environment. To address access to resources, Moreland and colleagues (2021) note how care coordinators in their program work “with the patient to either loan a device or find a solution to prevent lack of technology from becoming a barrier to treatment access.” As part of their intervention strategy, Johnston et al. (2019) provided Android smartphones to participants, as well as educational materials and location-based resources. In relation to other material needs women frequently have, such as food and clothing or diapers and formula for their children, White and colleagues (2022) noted the importance of keeping staff up to date on the availability of community resources for referral. To address stigma, Harper (2021) noted the importance of nonstigmatizing language in their treatment center for pregnant women, and Liang et al. (2021) highlighted the importance of the anonymous nature of online health communities for pregnant women’s discussion of stigmatized addiction topics. To support women involved with the criminal justice system, the intervention arm described by Staton et al. (2021) and Tillson et al. (2022) connects incarcerated women with peer navigators who provide telephone-based services for twelve weeks after their release from jail. Additional details on the social determinants of health addressed by the studies are available in Table 4.

Only two studies mentioned community engagement (Table 4). Jones et al. (2019) reported that the content of their Sex and Female Empowerment (SAFE) intervention was developed from qualitative interviews and pilot testing with women in treatment for OUD. Bardwell and colleagues (2021) noted that peer research assistants and women with lived experience assisted with interview guide development, and a peer research assistant helped facilitate study recruitment. For both studies, community engagement activities were classified as consultation, defined by Sanders Thompson and colleagues (2021) as asking community members “for advice on important elements of a project or activity” with the researchers “responsible for designing and implementing projects.”

Also shown in Table 4, six studies briefly reported some form of feedback after intervention implementation, and three reported plans to collect feedback (Forray et al., 2022; Patton et al., 2021; Staton et al., 2021). Strategies to collect feedback included qualitative interviews (Bardwell et al., 2021; Forray et al., 2022), focus groups (Staton et al., 2021), surveys (Johnston et al., 2019; Jones et al., 2021), mixed-methods evaluation (Patton et al., 2021), and verbal, more informal conversations with participants (McKiever et al., 2020; Rohrbaugh et al., 2019).

4. Discussion

Digital health is a rapidly expanding field and is being used to fill many of the treatment gaps for women with OUD. This scoping review describing digital health interventions for women with OUD yielded 15 articles and two abstracts with most published in the past three years. The COVID-19 pandemic likely accelerated this interest, with providers suddenly having to shift many of their services to a virtual environment and health regulators relaxing the requirements for MOUD via telehealth. This rapid shift in practice and expansion of access to care for OUD (Hailu et al., 2023) highlights the importance of reviewing current evidence to determine next best steps for continued progress in this field.

While articles reviewed in this study varied in the intervention type, study design, and outcomes measured, digital health interventions were most commonly cited as a potential solution to addressing issues related to access to care for women. However, only three of eleven completed studies focused on OUD treatment included MOUD utilization outcomes (Guille et al., 2020; McKiever et al., 2020; Smarony et al., 2022). One study used a nonrandomized controlled trial design, providing evidence of equivalence between virtual and in-person OUD treatment (Guille et al., 2020). None of the studies used a randomized controlled trial design, needed to establish stronger evidence related to efficacy. The ongoing type 1 effectiveness-implementation trial by Staton and colleagues (2021) may establish more evidence related to effectiveness for MOUD outcomes once completed. Nevertheless, the lack of digital health studies focused on MOUD efficacy outcomes among women represents an important area for future research. MOUD is considered the gold standard of care, reducing subsequent fatal overdoses (Larochelle et al., 2018) and relapse, but it remains difficult to access and is underutilized. This is particularly true for women; a recent study analyzing data from a large claims database found that from 2014–2020, females had lower rates of buprenorphine fills within 7 days of an opioid-related emergency department visit compared to males (Stevens et al., 2022).

Digital health solutions were also employed to address other social determinants of health that are common among women with OUD such as stigma, interpersonal violence, limited resources, and the housing environment, highlighting that digital interventions can potentially address many of the critical issues that are challenging to address in routine in-person clinical care. Interestingly, only two articles mentioned community engagement to inform the development and/or modification of the digital health intervention. Technological solutions to public health issues do not always achieve the outcomes expected by providers and researchers. Community engagement is critical to developing digital health solutions that effectively address the constantly evolving challenges presented by the opioid crisis. Given the complex nature of the barriers to care for women with OUD (Campbell et al., 2018; Office on Women’s Health, 2017; Stringer & Baker, 2018), community engagement is also important to ensuring those barriers are addressed in ways that are most relevant to them (Substance Abuse and Mental Health Services Administration, 2022). It is possible that community engagement may have been a part of the intervention development process that was not mentioned in the text of the articles. If this is the case, research teams should be encouraged to note any community engagement in their methods sections. This will help readers better understand the context of intervention development and can be an important source of information and lessons learned for other researchers.

Both instances of community engagement identified in this scoping review were classified as consultation, in which the research team asks community members for input, but the research team completes implementation without shared responsibility or decision-making (Sanders Thompson et al., 2021). It should be noted that consultation falls relatively early along the spectrum of community-engaged interactions. There is potential for advanced bidirectional learning and innovation if digital health researchers progress community engagement efforts further along the spectrum towards cooperation, collaboration, and partnership (Sanders Thompson et al., 2021). As researchers move along the spectrum of community-engaged interactions, the level of shared decision-making and trust with community members deepens (Sanders Thompson et al., 2021). For example, as defined by Sanders Thompson and colleagues, cooperation involves asking for input on a project, perhaps in a specified way (that is, in relation to the best way to recruit participants or in the development of questionnaires), and there is some level of shared decision-making between community members and the research team (Sanders Thompson et al., 2021). A deeper level of community engagement is collaboration, where community members and the research team are considered equal partners and share decision making at every stage of a project, including conception, design, and implementation (Sanders Thompson et al., 2021). In collaboration, “all partners are valued, benefit from the research, and share decision-making, power, and resources” (Sanders Thompson et al., 2021). The community-engaged interaction of partnership deepens the relationship between community members and the research team even further, representing the result of long-term relationship building, mutual understanding, and trust. Partnership is the result of a record of collaboration, not a single project (Sanders Thompson et al., 2021). One of the most challenging aspects of advancing along the spectrum of community-engaged interactions is the amount of time it may take members of the research team to build trusted relationships with community members. However, there is enormous potential for developing impactful and efficacious digital health interventions through community engagement, which makes investing time in these processes worthwhile. Investigators who are interested in involving community members in their research in meaningful ways should consider building multidisciplinary teams with expertise in community engagement and/or community-based participatory research.

Results of this review provide important insights into potential areas for future research. Most studies in this review focused on the peripartum period. Pregnancy presents an important window of opportunity for treatment with potential for a significant impact on women’s and children’s health (American College of Obstetricians and Gynecologists, 2017; Goodman et al., 2020; Shadowen et al., 2022). However, recent studies have documented the high risk of relapse, overdose, and death in the postpartum year (Schiff et al., 2018; Smid et al., 2019). Bruzelius & Martin found that from 2017 to 2020, the cumulative drug overdose mortality rate was significantly higher in the late postpartum period compared to during pregnancy (3.95 vs. 2.99 per 100,000) (Bruzelius & Martins, 2022). Additionally, when comparing January-June 2018 to July-December 2021, Han and colleagues observed nearly a doubling of the overdose mortality ratio during the late postpartum period (3.1 to 6.1 per 100,000 mothers with a live birth) (Han et al., 2023). Add to this the potential for loss of health insurance during this time (KFF, 2023; Ranji et al., 2021), it is imperative that substance use treatment and support continues throughout the postpartum year, particularly during the late postpartum period (Meinhofer et al., 2020; Shadowen et al., 2022). While further research is needed on what digital health interventions would be most efficacious during the postpartum period, areas of focus may include improving access to peer support and MOUD.

Furthermore, resources providing support for recovery and access to MOUD (such as extended Medicaid coverage) may become unavailable after the postpartum year (KFF, 2023), emphasizing the need for tools that address women’s needs for recovery support beyond the peripartum period, although there is currently a gap in the literature in this area. Indeed, both pregnant and non-pregnant women experience barriers to sustained engagement in OUD care (Elmore et al., 2023; Fiddian-Green et al., 2022; Phillippi et al., 2021). Additional opportunities for digital health interventions across the entirety of a woman’s life may include access to telehealth for MOUD and psychotherapy, support for MOUD adherence, stigma reduction, and the promotion of sustained recovery by improving social support.

While one study focused on a smartphone-based relapse-prevention system, none of the studies examined the use of mobile health applications (mHealth) to support women with OUD. This finding aligns with a recent review on mobile applications for OUD management conducted by Nuamah and colleagues (2020). Because mHealth is rapidly expanding and becoming more prominent in addiction treatment and recovery spaces, its effectiveness among women warrants further study. The Agency for Healthcare Research and Quality has developed a technical framework for the evaluation of mental health mobile applications that may serve as a starting point for future work (Agarwal et al., 2022). Additionally, none of the studies specifically addressed racial/ethnic disparities in access to care or treatment; given the known disparities in access to evidence-based medications for OUD among minoritized groups (Mark et al., 2023), this may be an important area for future study as well.

One issue that may arise in emphasizing digital health interventions for women with OUD is that of access to digital environments that facilitate digital health services. In settings that serve low-resource patients, shifting services to virtual formats may incidentally worsen disparities in access to care (Richardson et al., 2022). To prevent this from happening, practitioners and researchers might consider adopting Richardson and colleagues’ Framework for Digital Health Equity (Richardson et al., 2022). This framework builds on the National Institute on Minority Health and Health Disparities’ Research Framework by examining digital determinants of health within the digital environment, across multiple levels: individual, interpersonal, community, and societal (Richardson et al., 2022). Before implementing digital health interventions, it is important that the research team conduct a multilevel assessment of the digital determinants of health among the study population of interest (Richardson et al., 2022). For example, are there gaps in access to technology (individual level), and what is the frequency of shared device use (interpersonal level)? Is there sufficient infrastructure for high-speed internet (community level), and was the software being utilized in the intervention developed using equitable data standards, free of algorithmic bias (societal level)? The results from such an assessment will inform implementation and provide guidance on where additional efforts to support accessible digital environments is required.

One limitation to this scoping review is that we did not assess the quality of the studies included. Since the objective of this scoping review was to survey the current state of the literature on digital health interventions to support women with OUD, and since the study designs and outcomes measured varied so widely making them incomparable to one another, we did not feel that critical appraisal was necessary or appropriate for this review. As this field of inquiry continues to expand and more studies with similar designs and outcomes are conducted, perhaps a critical appraisal of the literature or a systematic review of intervention effectiveness may be more relevant in future work. Another limitation is due to the continually evolving nature of digital health: while we did our best to include a broad range of search terms, synonyms, and database-specific control language for digital health technologies, digital health methods continue to evolve. While our list of terms was extensive, it may be missing terms related to emerging digital health technologies and methods. Additionally, while we used four of the most popular databases in the field, the inclusion of additional databases may have yielded more results. Furthermore, a web-based search for non-peer reviewed reports and sources of evidence may have also enhanced results. However, this was beyond the scope of the current study. Finally, we originally set out to include a description of the extent to which each study conducted an evaluation of their implementation, including domains such as feasibility and acceptability. However, given the wide variety of ways “evaluation” may have been defined by study authors, we decided not to include this element in our description of the studies.

5. Conclusion

A variety of digital health interventions are currently being used to address OUD among women, with a particular focus on improving access to care. The results of this scoping review provide insights into areas for future work, including the need for evidence related to the efficacy of digital health interventions among women for the utilization of MOUD. Additionally, incorporating community engagement into intervention development is critical to ensuring the treatment and recovery needs of women with OUD are being met. Other areas for future research include digital health interventions for women that address OUD across the life course, as well as the development of mobile health applications.

Highlights.

• A variety of digital health interventions are currently being used to address OUD among women, with a particular focus on improving access to care.

• There is a lack of studies examining the efficacy of digital health interventions for the utilization of medications for opioid use disorder.

• Additionally, few studies mention the use of community engagement to inform the development and/or modification of digital health interventions for women.

• Other areas for future research include digital health interventions for women that address OUD across the life course, particularly during times of high risk for overdose such as the late postpartum period, as well as the development of mobile health applications.