Background & Aims

Research has supported efficacy and feasibility of Virtual Reality (VR) interventions for pediatric pain. There is also increasing attention to pain disparities in both adult and pediatric populations, as persons from racially minoritized and low socioeconomic backgrounds have a higher burden of pain and may not receive equitable care. Analogously, research documents a “digital divide” reflecting reduced access and utilization of health technologies among racially and socioeconomically marginalized groups. No research to date has specifically examined demographic or socioeconomic characteristics of participants included in pediatric VR pain interventions. It is critical to examine whether such interventions are repeating historical patterns of disparity and thus contributing to existing digital inequities. As such, the current study examined the demographic characterization of pediatric pain patients and families included in a recent systematic review of VR pain interventions.

Methods

Analysis included 29 US-based studies using immersive VR interventions for pediatric pain management. Studies were identified as part of a larger systematic review (PROSPERO #CRD42022307153) on immersive VR for pain. For the current study, only US-based studies were included given the specificity of the sociopolitical landscape in contextualizing sociodemographic identities. Two reviewers independently extracted data regarding the reporting and characterization of the following: (1) Demographic sample characteristics, including race/ethnicity and language spoken (participant age and gender distribution have been reported elsewhere) and (2) Socioeconomic characteristics, including level of education, family income/work status, and insurance status. Additional variables examined included geographic location of research (urban vs. rural setting), participant compensation, and virtual technology literacy or experience, as these variables were deemed relevant to VR intervention access.

Results

Of 29 included studies, 25 reported race/ethnicity (total n=1,139), with 561(49%) participants identifying as White/Caucasian, 174(15%) as Black/African-American, 71(6%) as Asian/Pacific Islander, 201(18%) as Hispanic/Latino, 10(1%) as American Indian, 106(9%) as Other/Did Not Specify, and 16(2%) as Biracial/Multiracial. Twenty-one studies reported language; of these 18(86%) studies required full fluency in English while 3(14%) allowed fluency in English or Spanish. Only 3 studies reported parental level of education, 1 reported household income, and 2 reported insurance status. Of 21 studies reporting geographic location, 14(78%) indicated urban setting, 3 indicated mixed urban-suburban setting, and 1 described a mixed urban-rural setting. Six articles reported whether participants were compensated and of these, only 1 reported incentive. Of the 3 studies who surveyed digital/virtual technology literacy or experience, 2 excluded patients who did not have access to a smartphone.

Conclusions

Among included studies, race and ethnicity were most consistently reported demographic factors, with most participants identifying as White/Caucasian. Key socioeconomic and related indicators relevant to VR use/access (household income, education, prior technology experience) were minimally reported. Most studies excluded non-English speaking youth. As such, VR use for pain management in socioeconomically and linguistically diverse pediatric populations remains largely unknown. This information is critical as socioeconomic and sociodemographic inequalities characterize the digital divide. Further, research was largely restricted to acute pain intervention within urban settings/hospitals, possibly promoting diversity and access. As virtual technologies are theorized to increase access for remote and marginalized groups, the over- representation of White urban participants in this analysis is concerning, particularly in light of recent calls for greater representation in pain science.

References

1.Trost, Z., France, C., Anam, M. & Shum, C. Virtual reality approaches to pain: toward a state of the science. PAIN 162, 325–331 (2021).
2.Chiao, F. B. & Wang, A. An Examination of Disparities in Pediatric Pain Management Centered on Socioeconomic Factors and Hospital Characteristics. J. Racial Ethn. Health Disparities 5, 73–77 (2018).
3.Nguyen, L. H., Dawson, J. E., Brooks, M., Khan, J. S. & Telusca, N. Disparities in Pain Management. Anesthesiol. Clin. 41, 471–488 (2023).
4.Saeed, S. A. & Masters, R. M. Disparities in Health Care and the Digital Divide. Curr. Psychiatry Rep. 23, 61 (2021).
5.Yao, R. et al. Inequities in Health Care Services Caused by the Adoption of Digital Health Technologies: Scoping Review. J. Med. Internet Res. 24, e34144 (2022).
6.Palermo, T. M. et al. Promoting Inclusion, Diversity, and Equity in Pain Science. Pain Med. Off. J. Am. Acad. Pain Med. 24, 105–109 (2023).

Presenting Author

Zina Trost

Poster Authors

Tatiana Shojaei

Psychology, B.S.

Texas A&M University

Lead Author

E-mail

Topics

  • Access to Care