BACKGROUND: There is a growing interest in developing scalable interventions, including internet-based cognitive behavioral therapy (iCBT), to meet the increasing demand for mental health services. Given the growth in diversity worldwide, it is essential that the clinical trials of iCBT for depression include diverse samples or, at least, report information on the race, ethnicity, or other background indicators of their samples. Unfortunately, the field lacks data on how well diversity is currently reported and represented in the iCBT literature.
OBJECTIVE: Thus, the main objective of this systematic review was to examine the overall reporting of racial and ethnic identities in published clinical trials of iCBT for depression. We also aimed to review the representation of specific racial and ethnic minoritized groups and the inclusion of alternative background indicators such as migration status or country of residence.
METHODS: Studies were included if they were randomized controlled trials in which iCBT was compared to a waiting list, care-as-usual, active control, or another iCBT. The included papers also had to have a focus on acute treatment (eg, 4 weeks to 6 months) of depression, be delivered via the internet on a website or a smartphone app and use guided or unguided self-help. Studies were initially identified from the METAPSY database (n=59) and then extended to include papers up to 2022, with papers retrieved from Embase, PubMed, PsycINFO, and Cochrane (n=3). Risk of bias assessment suggested that reported studies had at least some risk of bias due to use of self-report outcome measures.
RESULTS: A total of 62 iCBT randomized controlled trials representing 17,210 participants are summarized in this study. Out of those 62 papers, only 17 (27%) of the trials reported race, and only 12 (19%) reported ethnicity. Reporting outside of the United States was very poor, with the United States accounting for 15 (88%) out of 17 of studies that reported race and 9 (75%) out of 12 for ethnicity. Out of 3,623 participants whose race was reported in the systematic review, the racial category reported the most was White (n=2716, 74.9%), followed by Asian (n=209, 5.8%) and Black (n=274, 7.6%). Furthermore, only 25 (54%) out of the 46 papers conducted outside of the United States reported other background demographics.
CONCLUSIONS: It is important to note that the underreporting observed in this study does not necessarily indicate an underrepresentation in the actual study population. However, these findings highlight the poor reporting of race and ethnicity in iCBT trials for depression found in the literature. This lack of diversity reporting may have significant implications for the scalability of these interventions.

Asian is home to dozens of different ethnic groups that are characterised by fascinating social and cultural variations. Unfortunately, existing literature on the skin properties of Asians tends to group this diverse population solely based on skin colour, perpetuating the misconception and stereotype that all Asian skin is the same. While Asia is one of the largest continents in the world, the difference in the geographical location and climate have long shaped the population into various ethnic groups with significant differences in the collective and diverse customs, traditions, cultures and living habits. The diverse ethnic groups in this region hint us that their skin biophysical characteristics can be very different from each other. This review features the profiling of the distinctive skin biophysical properties of Asians. We learn more about the different ethnic groups in Asia and acknowledge the unique skin biophysical properties even from the same country.

Abstinence rates among smokers attempting to quit remain low despite the wide availability and accessibility of pharmacological smoking cessation treatments. In addition, the prevalence of cessation attempts and abstinence differs by individual-level social factors such as race and ethnicity. Clinical treatment of nicotine dependence also continues to be challenged by individual-level variability in effectiveness to promote abstinence. The use of tailored smoking cessation strategies that incorporate information on individual-level social and genetic factors hold promise, although additional pharmacogenomic knowledge is still needed. In particular, genetic variants associated with pharmacological responses to smoking cessation treatment have generally been conducted in populations with participants that self-identify as White race or who are determined to be of European genetic ancestry. These results may not adequately capture the variability across all smokers as a result of understudied differences in allele frequencies across genetic ancestry populations. This suggests that much of the current pharmacogenetic study results for smoking cessation may not apply to all populations. Therefore, clinical application of pharmacogenetic results may exacerbate health inequities by racial and ethnic groups. This scoping review examines the extent to which racial, ethnic, and ancestral groups that experience differences in smoking rates and smoking cessation are represented in the existing body of published pharmacogenetic studies of smoking cessation. We will summarize results by race, ethnicity, and ancestry across pharmacological treatments and study designs. We will also explore current opportunities and challenges in conducting pharmacogenomic research on smoking cessation that encourages greater participant diversity, including practical barriers to clinical utilization of pharmacological smoking cessation treatment and clinical implementation of pharmacogenetic knowledge.

South Asian individuals experience a higher burden of chronic diseases and limited access to health care services compared with their Caucasian peers. Digital health interventions can enhance the delivery of health care, minimize health inequities, and consequently improve health status among minority ethnic groups. However, it is unclear how South Asian people view and perceive the use of digital health technologies to support their health needs.
The aim of the review is to identify South Asian individuals\' experiences and attitudes of digital health and explore the barriers and facilitators affecting their use of digital health services.
The Arksey and O\'Malley methodological framework was used to guide this scoping review. Five electronic databases were examined for pertinent papers, which were augmented by searching bibliographies of the retrieved papers and gray literature. A total of 1328 potentially relevant papers were retrieved from the initial search, and the supplemental search added 7 papers to the final list of potentially included papers. Each paper on the initial inclusion list was independently reviewed, leaving 15 papers to be included in the review.
Data were analyzed thematically leading to the development of two overarching themes: (1) barriers to uptake of digital health and (2) facilitators of use of digital health services. There was a general consensus that South Asian communities still struggle with inadequate access to digital health technologies. Some studies suggest multiple initiatives to improve accessibility and acceptability of digital health services within South Asian communities in order to mitigate health disparities and develop a more inclusive health care system. These include the development of multiple-language and culturally sensitive interventions and digital skill development sessions. Most studies were conducted in South Asian countries, focusing on measurable outcomes of digital health interventions. Few explored the experiences and views of South Asian community members residing in the West as a minority ethnic group, for example, British South Asians.
Literature mapping proposes that South Asian people frequently struggle with a health care system that may limit their access to digital health services, and sometimes fails to consider social and cultural needs. There is growing evidence that digital health interventions have the potential to facilitate supported self-management, which is part of the plans to adopt person-centered care. These interventions are particularly important for overcoming some of the challenges, for example, time constraints, safety, and gender sensitivity, associated with the delivery of health care interventions in minority ethnic groups such as South Asians in the United Kingdom, and thus to improve minority ethnic groups\' access to health care services to support individual health needs, and consequently enhance health status.

Venous disease is prevalent, undertreated, and frequently unrecognized. During the past two decades, new treatment modalities have changed how venous disease is approached. Some of these treatment modalities are only available in certain centers or locations and access to care could be inequitable. Although venous disease affects millions in the United States, we have little understanding of the gender, socioeconomic, and ethnic disparities in both superficial and deep venous disease presentation. In an effort to better understand the treatment of male and female patients from different gender, ethnic, and socioeconomic backgrounds, literature searches were conducted to investigate how these patients were evaluated and treated. PubMed was used to search literature using the terms \"venous insufficiency,\" \"superficial venous disease,\" \"venous thromboembolism,\" \"deep vein thrombosis,\" \"DVT,\" \"May-Thurner,\" and \"pulmonary embolism,\" with gender, sex, racial, and socioeconomic disparities and differences within the keywords. In addition, once articles were discovered, the \"similar articles\" function was used to expand the search. The included studies were restricted to those reported from 1995 to the present. Given the paucity of data, no study was excluded. It is readily apparent that there is not enough data to make decisions that would modify treatment to affect the outcomes of patients with differing backgrounds and gender. Studies currently are limited to evaluating patients by sex assigned at birth without interrogation of their identified gender. It is imperative that consideration is given to evaluating gender and ethnic differences, because treatment options might need to be tailored accordingly. Outreach and education for underserved patient populations with improvement in access to care must also be incorporated into the healthcare system. Additional work in this area is required. Further data collection and research related to demographic disparities among patients with venous disease is necessary to better understand the differences that could change treatment algorithms tailored to specific groups.

BACKGROUND: Fatigue is one of the most common symptoms of systemic lupus erythematosus (SLE) worldwide, yet it remains poorly assessed and managed. The lack of universal definition and standard measurement of fatigue may add to the continued limitations in its understanding across cultures.
OBJECTIVE: The psycho-sociocultural underpinnings of fatigue are understudied; therefore, in this paper, we conducted a systematic review to understand a transcultural perspective of SLE-related fatigue.
METHODS: Following PRISMA (Preferred Reporting items for Systematic Reviews and Meta-Analysis) systematic review guidelines, we searched CINAHL Complete, Scopus, and PubMed databases for all published articles covered until the search date. Search was expanded using citation and web search. A 3-step process was used to identify articles meeting the inclusion criteria. The results were analyzed using narrative synthesis.
RESULTS: From a total of 370 (n=364, 98.4% scientific databases; n=6, 1.6% web and citation search) articles searched, 18 (4.9%) studies met the inclusion and exclusion criteria and were included in this review. All (18/18, 100%) studies enrolled primarily female participants, and half (9/18, 50%) had cross-sectional designs. Although race was not reported in all studies, most studies had White racial background as the largest proportion of their samples. A majority (7/18, 39%) of the studies were conducted in the United States. Using a narrative synthesis, the prominent themes drawn based on the domains of the culture care theory (CCT) and the sunrise enabler were as follows: SLE-related fatigue (1) as an integral component of the disease process, (2) as a personal challenge, and (3) as a psychosocial dimension.
CONCLUSIONS: CCT and sunrise enabler by Leininger guided this review. There are still gaps on how other domains of the CCT and sunrise enabler might influence SLE-related fatigue experience, assessment, and evaluation. The findings from this review showed that SLE-related fatigue has disease, personal, and psychosocial components. Thus, a purely subjective assessment of fatigue in SLE and even other conditions may limit a more accurate assessment and management. The inclusion of disease, personal, and psychosocial indicators is warranted and essential. A culturally sensitive and congruent assessment as well as evaluation models and measurement tools should be developed to capture fatigue experiences accurately. In addition, since global migration is inevitable, advancement in symptom management strategies should coincide with the understanding that fatigue has subjective and objective indicators present across cultures.

Globally, mental disorders are rising with increasing urbanization. India has the world\'s second-largest tribal population and it is critical to appreciate the mental health problems in this population. However, the extent of mental health issues among tribal populations is unknown. Against this background, we systematically reviewed community-based studies on mental health issues among tribal populations in India.
Online databases PubMed, Embase, ProQuest databases and Google Scholar were searched and articles published between January 1990 and May 2021 including primary community-based quantitative observational studies focused exclusively on tribal population were retrieved. PRISMA guidelines were followed and this review was registered on PROSPERO (CRD42020178099).
A total of 935 articles were identified, of which 63 were selected for full-text review, and finally, 11 studies were included. Seven studies examined alcohol use disorder with a pooled prevalence of 40 per cent. Two studies reported on suicidal attempts. A few studies mentioned anxiety, depression and other mental health conditions.
: This systematic review established that a few community-based primary studies were conducted on mental health issues among tribal populations over the last three decades. Among these, fewer studies focused exclusively on tribal communities. The studies differed in their study design and the tools used. The findings of these investigations highlighted a limited range of mental health issues, primarily alcoholism, anxiety, depression and suicide.

Digital health interventions (DHIs) for the prevention and management of cardiometabolic diseases have become increasingly common. However, there is limited evidence for the suitability of these approaches in minority ethnic populations, who are at an increased risk of these diseases.
This study aimed to investigate the use of DHIs for cardiovascular disease and type 2 diabetes among minority ethnic populations in countries with a majority of White, English-speaking populations, focusing on people who identified as South Asian, Black, or African American.
A realist methodology framework was followed. A literature search was conducted to develop context-mechanism-outcome configurations, including the contexts in which DHIs work for the target minority ethnic groups, mechanisms that these contexts trigger, and resulting health outcomes. After systematic searches, a qualitative analysis of the included studies was conducted using deductive and inductive coding.
A total of 15 studies on the uptake of DHIs for cardiovascular disease or diabetes were identified, of which 13 (87%) focused on people with an African-American background. The review found evidence supporting the use of DHIs in minority ethnic populations when specific factors are considered in implementation and design, including patients\' beliefs, health needs, education and literacy levels, material circumstances, culture, social networks, and wider community and the supporting health care systems.
Our context-mechanism-outcome configurations provide a useful guide for the future development of DHIs targeted at South Asian and Black minority ethnic populations, with specific recommendations for improving cultural competency and promoting accessibility and inclusivity of design.

Significant disparities exist between different ethnic groups when it comes to participation in colorectal cancer (CRC) screening programmes. A variety of interventions have been proposed to improve participation rates of ethnic minorities for CRC screening. This systematic review aims to appraise the evidence available from published randomised controlled trials (RCTs) and to identify effective interventions aimed at promoting CRC screening amongst underserved ethnic minorities.
We searched EmBASE, Medline, PsychInfo, Scopus and CINAHL for RCTs that analysed interventions to promote CRC screening in all ethnic minorities. CRC screening was measured as documented or self-reported screening rates. The protocol of this study was registered prospectively on PROSPERO with the registration number CRD42020216384.
We identified 42 relevant RCT articles, out of 1805 articles highlighted by the initial search. All except one were conducted in the US. The most frequently studied ethnic groups were African-Americans (33%), East Asians (30%), and Hispanics/Latinos (23%). In total, 7/42 (16%) RCTs had multiple arms. Interventions mainly intended to educate (52%), provide patient navigation services (21%), or provide a combination of these interventions (19%). We demonstrate that combination methods are most effective.
Many RCTs, mostly in the US, have trialed interventions aimed to increase CRC screening uptake amongst ethnic minorities to varying success. We conclude that using a combination of methods with patient navigation, education, and cultural tailoring is most effective at increasing CRC screening uptake amongst ethnic minorities. This highlights that multiple factors may hinder CRC screening and finding a one-size-fits-all solution that can be reliably implemented among different cultures and countries may be complex.

OBJECTIVE: This study evaluated the differences in clinical outcomes of COVID-19 infection between ethnic minorities and the White ethnic group in the UK.
METHODS: Systematic review and meta-analysis.
METHODS: This study included adult residents in the UK with confirmed COVID-19 infection. The outcomes evaluated in this study were mortality, intensive care unit (ICU) admission and invasive mechanical ventilation (IMV). Outcome data were compared between individuals from ethnic minority groups and individuals from a White ethnic background. MEDLINE, Embase, Cochrane, medRxiv and PROSPERO were searched for articles published between May 2020 and April 2021. The risk of bias was evaluated using the Newcastle-Ottawa Scale checklist.
UNASSIGNED: CRD42021248117.
RESULTS: Fourteen studies (767,177 participants) were included in the current review. In the adjusted analysis, the pooled odds ratio (OR) for mortality following COVID-19 infection was higher for Black (OR 1.83, 95% confidence interval [CI]: 1.21-2.76, number of studies [k] = 6), Asian (OR 1.16, 95% CI: 0.85-1.57, k = 6) and Mixed and Other (MO) ethnic groups (OR 1.12, 95% CI: 1.04-1.20, k = 5) compared with the White ethnic group. The adjusted and unadjusted ORs of ICU admission for many of the ethnic minority groups were more than double the OR values for the White ethnic group (Black ethnic group = OR 2.32, 95% CI: 1.73-3.11, k = 5; Asian ethnic group = OR 2.34, 95% CI: 1.89-2.90, k = 5; and MO ethnic group = OR 2.26, 95% CI: 1.64-3.11, k = 4). In the adjusted analysis for IMV, the ORs were similarly significantly raised in ethnic minority groups compared with the White ethnic group (Black ethic group = OR 2.03, 95% CI: 1.80-2.29, k = 3; Asian ethnic group = OR 1.84, 95% CI: 1.20-2.80, k = 3; and MO ethnic group = OR 2.09, 95% CI: 1.35-3.22, k = 3).
CONCLUSIONS: This review found that in the UK, Black, Asian and MO ethnic groups experienced increased COVID-19-related disease severity and mortality compared with the White ethnic group majority.