Digital health interventions for women in frontline public service roles: A systematic review of effectiveness in reducing substance use

Frontline occupations, including military, healthcare, and first responders, often include frequent exposure to traumatic events, increasing the risk of substance use disorders (SUDs). Research has shown that those in high-intensity occupations are at higher risk of developing SUDs compared to the general population. Women face unique experiences related to substance use, including greater functional impairment and barriers to treatment access. Yet, understanding of the effectiveness of digital health technologies in addressing substance use among women in frontline occupations is limited. This systematic review evaluates the effectiveness of digital health interventions in reducing substance use among women in frontline roles. Four databases (PsycINFO, Ovid MEDLINE, Embase, PsycArticles) were searched for English language full-text articles (2007-2024) that (1) evaluated a digital intervention designed to reduce substance use, (2) reported changes in substance use outcomes such as frequency, intensity or duration, using validated tools (3) included current or former frontline public service workers, and (4) included women as the primary target population or as a subgroup within the sample. 13 papers met inclusion criteria, focusing on eight distinct web and mobile-based interventions for alcohol, tobacco and illicit substances. Most studies (n = 11) reported substantial post-intervention reductions in alcohol and tobacco use, although results for PTSD symptoms, illicit drug use, and quality of life were mixed. This review highlights the potential of digital health interventions for reducing substance use but underscores significant gaps in research. The scarcity of studies focused on women, small and heterogeneous samples, and focus on veterans limits the generalisability to women in frontline roles. These gaps present a pressing challenge in understanding gender-specific digital intervention efficacy. Future research should prioritise larger, representative samples of women across diverse frontline occupations to drive the development of digital technologies tailored to the unique challenges faced by women in these roles.