Equity implications of extended reality technologies for health and procedural anxiety: a systematic review and implementation-focused framework

Extended Reality (XR) applications are gaining support as a method of reducing anxieties about medical treatments and conditions, however their potential impacts on health service inequalities remain under-researched. We therefore undertook a realist synthesis of evidence relating to the equity implications of these types of intervention. Specifically, searches of MEDLINE, Embase, APA PsycINFO, and Epistemonikos were conducted in May 2023, to identify reviews of patient-directed XR interventions for health and procedural anxiety. Equity-relevant data were extracted from records (n = 56) that met these criteria, and from individual trials (n = 63) evaluated within five priority reviews. Analyses deductively categorised data into salient, implementation-focused themes, with results highlighting various situation- and technology-based mechanisms that impact on the availability, accessibility and/or acceptability of services. Our ‘double jeopardy, common impact’ framework subsequently models unique pathways through which XR could help address health disparities, but also accelerate or even generate inequity across different systems, communities and individuals. Overall, despite growing positive assertions about XR’s capabilities in this area, we emphasise the need for taking a cautious, inclusive approach to implementation in future programmes.