PROJECT SUMMARY Although digital health technologies are now widely available for both therapeutic and monitoring applications, there are racial and ethnic disparities in uptake and effectiveness of digital health interventions. Of relevance to our parent HEAL study examining a digital health intervention (virtual reality) for pain management, recent data indicate that non-Hispanic Black and Hispanic patients are less likely to have access to digital health information and more likely to report severe pain than non-Hispanic whites. In addition to disparities in access and adoption of digital health interventions, there are known disparities in the incidence and reporting of pain by racial and ethnic minorities. For example, study of 2000 patients found that non-Hispanic Black and Hispanic patients were more likely to report severe pain than non-Hispanic whites. The proposed study for this Diversity, Inclusion and Engagement Supplement to our NIH HEAL study evaluating the role of therapeutic VR for chronic lower back pain (cLBP) will provide a framework to advance diversity and inclusion efforts for future digital health trials at our medical center and beyond. Further, it will enhance the parent study by seeking to increase the proportion of participants with historically less access to and familiarity with digital technologies while enhancing overall participant racial and ethnic diversity. Using the NIH Stage Model for Behavioral Intervention Development supported by advances in artificial intelligence (AI)-driven cohort building tools, we propose to meaningfully improve enrollment rates of non-Hispanic Black and Hispanic participants in our parent NIH HEAL study by achieving two aims: (1) tailor recruitment materials for non-Hispanic Black and Hispanic patients with cLBP in partnership with representative patient advisory boards; and (2) oversample non-Hispanic Black and Hispanic participants in parent study using an AI-driven cohort building tool housed within the electronic health record.

PROJECT NARRATIVE Although digital health technologies are now widely available for both therapeutic and monitoring applications, there are disparities in patient knowledge, attitudes, beliefs and preferences regarding uptake and effectiveness of digital health interventions. The proposed study for this Diversity, Inclusion and Engagement Supplement to our NIH HEAL study evaluating the role of therapeutic VR for chronic lower back pain (cLBP) will provide a framework to advance diversity and inclusion efforts for future digital health trials at our medical center and beyond. Further, it will enhance the parent study by seeking to increase the proportion of participants with historically less access to and familiarity with digital technologies while increasing enrollment rates of non- Hispanic Black and Hispanic participants.